• Client: Small Group Self-Insured Payer
  • Industry: Healthcare/Health Benefits
  • Region: Austin, TX

Payer Analytics to Optimize Care Coordination

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Integrated disparate data systems

Created a single source of truth by combining claims data, CRM records, and clinical risk tools.

Streamlined patient risk assessment

Built automated processes to identify and flag high-risk patients who need care coordination.

Improved care coordination workflow

Developed comprehensive patient profiles that give care managers complete health histories and risk factors

An innovative health benefits provider for small businesses faced a significant data challenge. 

Despite having access to extensive patient enrollment and claims information, the company struggled with disparate data sources and ad hoc analytics processes. This fragmented approach hindered their ability to become a truly data-driven organization.

The company needed a solution to integrate their internal application data with claims information so they could identify patients who could benefit from targeted care coordination and case management. 

This case study explores how Keywell helped them overcome these challenges, so they could improve patient care, optimize their health plan offering, and transform their approach to data analytics.

The Quest for Data-Driven Care Management

When Keywell engaged with this company, the team had disparate patient enrollment and claims data, as well as disjointed analytics processes.

Their existing approach made it difficult to:

  • Accurately identify high-risk patients or those with specific chronic conditions who could benefit most from care coordination
  • Efficiently enroll patients in appropriate care management programs.
  • Track and measure the outcomes of their care coordination efforts.
  • Demonstrate the value of these programs to their small business clients, who bear a significant portion of premium costs.

The company needed a more streamlined, data-driven approach to connect the dots between patient data, risk assessment, care coordination, and outcomes measurement. Their ultimate goals were twofold: reduce healthcare costs for their small business clients and improve the quality of care for patients.

Connecting the Dots: A Strategic Data Integration Solution

To address the fragmented data challenge and improve care management, we developed a comprehensive data integration and analytics strategy. 

Our approach included several key components:

  • Integrating outputs from a procedure risk grouper, which improved the accuracy of patient risk assessment.
  • Enriching data with clinical classification software to better segment patient populations.
  • Developing intuitive patient profiles using dashboards to provide a more complete picture of individual health status.
  • Creating a data strategy and future roadmap for various organizational use cases.

This integrated approach enabled the organization to more effectively identify high-risk patients and allocate resources for care management, while also laying the groundwork for future analytics capabilities.

Measurable Care Coordination Impacts

As a result of our collaborative efforts, the health plan’s case management team achieved several key improvements:

  • A reliable, data-driven list of patients for targeted case management outreach.
  • The ability to quickly review reasons for patient identification and easily access claims history.
  • Increased confidence in resource allocation and execution of their long-term data architecture strategy.
  • Improved ability to demonstrate clear value to their small business clients.

While the initial engagement with this company focused on strategy and evaluation, our expertise extends to building and implementing advanced analytics solutions for this type of use case.

Are you looking for innovative approaches to healthcare data integration? Contact us to discuss your unique challenges with our team.

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