Managed Care - September 2008 - (Page 20)

Archimedes isn’t the only modeling program Many vendors compete to analyze your data avid Eddy, MD, PhD, is one of the pioneers of medical predictive modeling, which combines sophisticated math tools with computers and biological and medical data to improve health care decisionmaking. Applications that combine predictive modeling and decision support can spot at-risk patients and potentially help them avoid diseases, saving millions. Even more cost-saving is the ability of these applications to find the least expensive treatment options — the next frontier in controlling health care costs. Besides Eddy’s San Franciscobased predictive modeling company, Archimedes, several others compete for a share of this burgeoning market. Their clients include health plans, drugmakers, thirdparty administrators, disease management concerns, government programs such as Medicaid, and others. Just as television can present an image in different ways , such as with cathode ray projection tubes, LCDs, and plasma displays, the companies arrive at basically the same goal of recommending care plans after sifting through claim data and possibly lab results, though their methods vary. All group by disease and other means and give a financial measure to risk. They differentiate themselves largely by the way D they solve problems, the quality of their support, ease of product use, experience, price, ability to customize with add-on modules, and adaptability to clients’ existing software. What follows is a list of Archimedes’ competitors in the managed care market, where Archimedes has 20 percent of its clients. A greater share of Archimedes users are pharmaceutical companies, though the MCO market is targeted for growth. This list is by no means inclusive. Ingenix (Impact Pro) Ingenix is a wholly owned subsidiary of UnitedHealth Group. Impact Pro was first available in 2002 and has become the market leader by number of lives — 75 million. The company boasts 76 clients, the largest (22 million lives) being OptumHealth, another United subsidiary. Most other clients are medium to large carriers. Based on a person’s claims and lab result history, it predicts the person’s likely use of health care services and the associated costs over the course of the year, and the likelihood of that person being hospitalized. It will recommend evidence-based interventions. It does the same thing for an employer group, community, or any other population. In addition, Impact Pro groups patients by disease or by wellness initiative, such as diabetes and smoking cessation. This is a rule-based model that helps clinicians to get at the underlying causes of disease states. The company judges its success by the increase in the number of people who require treatment. Impact Pro, already used over the Web, can coordinate with electronic medical records and is just starting to be used in physicians’ offices. Clients are charged per member per month. It can be hosted by the client or by Ingenix. MEDai (Risk Navigator Clinical) MEDai, founded by two respiratory therapists, was purchased earlier this year by Elsevier, the large medical reference publisher in the Netherlands that is best known for titles such as Gray’s Anatomy, Nelson’s Pediatrics, and Braunwald’s Heart Disease. In 2000, MEDai’s Risk Navigator Clinical software was one of the first predictive modeling programs for payers to come on the market (a similar MEDai hospital product came out in 1996). Some 48 clients use the payer product that encompasses 20 million covered lives. Among them are third-party administrators, employer groups, and medium to large health plans such as Health Net and various Blues $1,000. If they did that, the answer they would get would be wrong because of that mistake. You could also misuse ARCHeS — or an ax, or Excel, or the English language — intentionally. Right now the analyses are being done by us, so it’s not as though a client can tell us to put in a phony number to make a treatment look good, for example. On the other hand, when ARCHeS is available, someone could do that. We’re thinking of ways of certifying the results, because we don’t want the name Archimedes attached to a purposely inaccurate analysis. MC: And what about the example of giving patientspecific information to physicians — who’s to say he will follow the advice generated by Archimedes? EDDY: At this time we do not foresee the model forcing a physician to do anything. The role of the model is to provide information — better information than has been available in the past to be sure — but still just information. It is up to the physician to use the information provided by the model along with other information to make a decision. 20 MANAGED CARE / SEPTEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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