Improving health outcomes, reducing costs and increasing insurance reimbursements
The Business Challenge
Reduce the number of hospital readmissions for congestive heart failure (CHF) patients, thereby improving patient care, substantially decreasing costs (an average of $60,000 per CHF readmission) and increasing Centers for Medicare and Medicaid Services (CMS) reimbursement rates for a US-based 18-hospital system.
Unisys Advanced Analytics services to develop a Social Determinants of Health (SDoH) Readmission Risk model that determines 30-day readmission risk for individual CHF patients (incl. home/work environment, age, activity, income, diet, education, and access to care).
Results and Benefits
- Identified patients at risk of readmission with 78% accuracy, improving upon a clinical-only readmission predictive model that was 60% accurate
- Achieved the potential to decrease CHF costs by $12M-$24M annually (10-20%) for the four hospitals in the pilot program
- Gained a healthcare analytics platform that can include other disease states
- Enabled proactive care by identifying SDoH risk at an individual patient or member level