IntegerHealth ‒ A Revolutionary Healthcare Technology Company

IntegerHealth is a healthcare analytics company that quantifies healthcare outcomes for insurers, health systems and employers ‒ something that no one else does. Our patented solutions merge cost and quality into a single objective dollar value on each outcome, generating actionable analytics that drive down healthcare costs while improving the quality of care for health plans, wellness programs and workers’ compensation.

Watch a 3-minute video on why IntegerHealth’s patented outcome analytics are unlike anything else.

Your Problem

You know to the penny what you are paying for healthcare ‒ the claims that you pay to doctors and hospitals.

But you don't know what you are getting in return for those dollars.

With IntegerHealth ‒ You will!

Outcome Analytics

Watch a 16-minute video showing how IntegerHealth’s patented outcome analytics drive down costs while improving care. Insurers and health systems can use the analytics shown in this video both as employers themselves and in their operations ‒ health insurers for their members and health systems for their patients.

A core problem in healthcare is that it costs too much. To combat that, we have all measured many things. But we haven’t measured the one thing that matters most ‒ the patient’s outcome. That is what we do. 20% to 30% of healthcare spending is wasted on poor or ineffective care. Focusing on outcomes ‒ You can root that out, while improving the quality of care. Conventional metrics focus on either what the doctor charges, or on quality metrics ‒ that measure the process. What the doctor did, or did not do. Did the doctor follow standard protocols for treating a particular diagnosis? These quality metrics are merely proxies for the only thing that really matters ‒ The patient’s outcome.

Did the patient get better? And if they did, how much did it cost and how long did it take? At IntegerHealth ‒ We quantify those outcomes by merging cost and quality into a single actionable dollar value. For you, this means seeing the whole picture ‒ Not just what you paid, but what you got in return for your healthcare dollars.

Foundational – Measurement Backbone

Our outcome analytics are foundational – the measurement backbone that objectively determines whether care is working across populations as well as across healthcare delivery and financing models. This measurement backbone enables cost, quality and AI tools to operate against a single, objective, outcome-based truth. It is the core measurement that conventional healthcare metrics do not provide – and cannot replace.

Issued U.S. Patents

We have six issued U.S. patents across five active patent families with continuations on file – No one else does what we do.

Tree Frog Navigation System – Guides users through complex data in an intuitive and visual way (U.S. Patent Nos. 11,809,676 B2 & 12,547,291 B2).

Claims + Absence Costs Solution – Quantifies outcomes for employers by combining the medical and pharmacy claims with the productivity costs of illnesses and injuries (U.S. Patent No. 12,159,708 B2).

Wellness Program ROI Calculator – Calculates the financial return on wellness programs by measuring the improvement in the healthcare and productivity costs of participating employees (U.S. Patent No. 12,191,022 B2).

Claims per Healthy Day Solution – Quantifies the risk-adjusted claims cost per day to keep a person healthy (U.S. Patent No. 12,254,976 B2).

High-Cost Medical Case AI Prediction Engine – Employs AI, machine learning and natural language processing to predict potential high-cost medical and workers’ compensation cases as soon as the illness or injury occurs (U.S. Patent No. 12,400,188 B1).

How?

IntegerHealth quantifies healthcare outcomes, merging cost and quality into a single dollar value across diagnoses, providers, plans, programs and treatment patterns. Now the input into the healthcare equation – the claims dollars – can be compared to the output – the patient’s outcome. By measuring outcomes, we generate actionable analytics – Driving down healthcare costs while improving the quality of care.

We have two ways of quantifying outcomes depending on the data available:

• Claims + Absence Costs – When we have medical and pharmacy claims and an employer’s HR absence records, we calculate the risk-adjusted total costs (claims + absence) to get an employee back to work and keep them there. We use this solution to quantify the employee outcomes for employers that self-insure their health plans and workers’ compensation programs (including insurers and health systems with respect to their own employee plans and programs); and we also use it with workers’ compensation insurers and TPAs, who can substitute the lost-wage indemnity payments to injured employees for the absence costs.
• Claims per Healthy Day – When we have just the claims, we calculate the risk-adjusted claims per healthy day. Instead of asking how much it costs, and how long it takes, to get an employee better and back to work, we ask how much it costs in claims per day to keep someone healthy. We use this solution for: (1) health insurance companies, TPAs and Medicare Advantage plans when quantifying the outcomes of their members (MA plans can also use this solution when structuring their CMS bids); (2) health systems, ACOs and provider groups taking on risk when quantifying the outcomes of their patients; (3) state and other multi-employer health plans when quantifying the outcomes of their members; and (4) self-insured employers when quantifying the outcomes of the dependents under their health plans.

Quantifying Outcomes Gives New Power

When you quantify healthcare outcomes, you can do things that you could never do before to drive down your costs while improving the quality of care. See the case study on the “Resources” page on how our analytics drove down the City of Fort Worth’s costs 23%!

• Evaluate Based on the Outcomes Achieved – Who are the best PCPs for treating diabetes or the best surgeons for knees? Are your PCPs referring to the right specialists and surgeons? Which hospitals are best, diagnosis-by-diagnosis? On treatment patterns, are you getting better outcomes sending back patients to chiropractors or physical therapists? Which case managers and workers’ compensation adjusters are getting the best results, both by diagnosis and overall?
• Steer & Direct Care – Steer patients to the best providers through your case managers working with chronically ill and high-cost claimants and through the PCPs making referrals to specialists and surgeons, which is particularly powerful when an employer has an on-site clinic that is the first stop for most of its employees. Integrate outcome analytics into your health plan’s “Find a Provider” tool. In workers’ compensation, 34 states allow some form of direction of care, from establishing a provider network that the injured employee has to stay within, setting up a provider panel from whom the employee must choose, or actually directing the injured employee to a specific doctor.
• Optimize Plan & Network Design – Compare outcomes under plan options (PPO vs. HMO vs. HDHP). Evaluate and compare health systems and insurers based on the outcomes they deliver and use that in contract negotiations. Drive down costs and improve quality by sculpting provider networks – building narrow networks of the best providers based on their outcomes, stratifying the network by decreasing or eliminating copays and out-of-pocket costs when patients go to the best doctors, or contributing to their HSAs when they do so.
• Population Health & Wellness Programs – Evaluate population health and calculate the true ROI on disease management and wellness programs – including GLP-1 weight loss drugs – based on the outcomes that they achieve: The decrease, if any, in the medical and pharmacy claims, and medically-related absence costs, of the participating employees. Anything else is just fluff.
• Guided Analytics – Our proprietary groupers and algorithms analyze the claims to tell a story. Not only what happened, but why?