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Our story began in 2005 when we identified an urgent need in emergency health care. Emergency medical service (EMS) professionals didn’t have real-time information on patients prior to arriving at the hospital, which limited their ability to provide accurate and often life-saving treatment. In response, we developed a solution that provided web-based data analytics in the pre-hospital care field. This pre-Affordable Care Act solution centered on providing a complete digital picture of a person’s health available in real-time to those who needed it most - patients, first responders, hospitals, and ER physicians.
Through this work, we quickly identified a much larger issue within the U.S. healthcare ecosystem. While digital transformation is well underway, the fact remains that healthcare costs in the U.S. continue to skyrocket, and the quality of care continues to fall behind other nations. Heightened regulatory requirements and growing competitive pressure from large, national health plans have also increased the need for payer organizations to innovate. Today’s health plans need to simultaneously execute their care management objectives, adapt to emerging requirements without disruption, and drive innovation across the organization.
We recognized that real payer innovation requires taking a new and holistic approach to data, with more diverse data sources that are incorporated and managed to deliver real-time insights directly within the plan’s medical management platform. With this vision for connecting stakeholders, solutions and data as a foundation, our cloud-native Affinitē platform was officially born.
In conjunction with embedded, machine learning data science, the platform instantly risk stratifies, segments, and identifies actionable interventions to empower every stakeholder with a 360-degree view of member status, quality, and risk performance. With a universal, real-time dynamic platform, health plans can feel confident using medical management to drive massive benefits, and as a strategic tool for execution and long-term innovation.
Affinitē seamlessly embeds robust predictive data models that encompass myriad data points spanning behavioral, clinical, and non-traditional sources including SDoH, HIEs, case management notes, remote monitoring results, and wearables, among others. With these sources available at the ready, health plans can uncover actionable insights that positively impact member health and increase collaboration with internal and external stakeholders.
Today, the Vital Data Technology data science team has accurately identified thousands of high-risk members, thereby allowing our customers to engage and assist them before their health worsened. Together, we are continuing to deploy multi-layered risk models, offer personalized action plans, and deliver next-best actions that are essential components of a high-functioning medical and behavioral health program.
With Affinitē data science models, health plans can accurately predict which members are the highest risk for certain health conditions, such as depression, diabetes, or pre-term birth, leading to improved health outcomes and cost savings. Our expert data science modeling capabilities can also help teams identify members that are most likely to engage in case management and more likely to be high cost.
As an example, a large Blue Cross Blue Shield client saw the following improvements to their care management performance within the first year without increasing staff:
- Care management team outreach increased by 56%
- Members enrolled in care management via outreach increased by 50%
- Hospital admissions decreased by 5.9%
- ER visits decreased 2.9%
We also know that health plans need to increase their operational efficiencies, especially in this market with all the current staffing shortages. Automation can generate touchpoints, referrals, and assignments sent directly to the correct recipient, creating a more efficient workflow for staff. A completely streamlined workflow led to the following results for this same client:
- 60% reduction in time to open a case
- 87% increase in care management referrals
- 30% increase in new cases
- 9% increase in active cases managed
Our support now extends to all plan types across the healthcare ecosystem, including those operating in Medicaid, Commercial, Exchange, Medicare, and Behavioral Health. Our current clients are diverse and include a small, regional health plan as well as a large Blues plan with millions of members. We act as a strategic partner to our clients and take a clinical and operational consulting approach to our implementation and ongoing engagement.
In 2022 and beyond, we continue to expand on our main vision – to transform the healthcare ecosystem by empowering healthcare stakeholders with prescriptive insights to improve member health and lower costs.
