Must we choose?

The actuarial problem: 10% of you will need care next year; we just don’t know who you are or what care might work best.

• The latter part of the 20th century saw the persistent and escalating rise of healthcare costs in the US.
• Chronic condition care became the main source of increasing costs.
• Systemization of care management became desirable to decrease variation in utilization and to decrease uncertainty of cost and outcome.

Systemization took the form of managed care organizations, both payers and providers. Advanced analytics to study costs, utilization of services, and outcomes for defined populations of participants became a lynch pin to improve these three metrics.

The quality of information and insights obtained from either description or predictive analytics has improved over time. Automating processes and analysis and improving access to more data has led to precision insights. Using advanced methodology precision means the ability to see cost, utilization, and outcomes at an individual level while adding the important risk features of comorbid conditions, epi-social status, and behavioral needs.

Precision provides the ability to recommend specific actions to care givers related not only to a primary diagnosis or relative cost and utilization, but also to provide specific guidance for approaches to impact these three additional determinants of health within the bounds of available resources – comorbid conditions, epi-social impacts, and behavioral needs.

The flip side of precision is an ability to assist with planning what resources may be needed in the future to attain the wellbeing goals of the organization. For example, if in a given zip code or cohort of individuals some service not now available is surfaced at a high frequency as being useful, it gives the care management team a chance to address within the bounds of usual business practice.

Analytics, of course, don’t take care of individuals seeking healthcare. There has been a gap historically between analytic insights and the ability to integrate those insights into actionable and impactful and personalized interventions through various care management.

This is what precision insights leading to personalized actions delivers. Close the gap.

This is not an either-or debate. Precision insights may be seen as a complementary next layer of advanced insights that augment the benefits of descriptive and predictive analytics. All are needed to see a population of participants being attended through different lenses each providing valuable insights that assist with achieving wellbeing and clinical and financial risk goals.

More is on the way. The analytics world is advancing rapidly using advances in data access, interoperability, and standardization with FHIR and genomic and phenotypic packets. Large language model AI as well as advances in computing and process automation are making precision insights more useful and beneficial to both individuals receiving care and for the care delivery teams.

*Trusted Care, an Austin-based analytics firm, is a leader in Precision Insights. Green Room assists Trusted Care as they bring to market their latest Precision Insights for greater wellbeing and less risk.