This 12-month randomized, prospective study of 39,462 members of QualChoice, a University Hospitals Health System healthcare plan in Cleveland, Ohio, is the first ever large-scale study of a clinical decision support system conducted in an outpatient health plan environment. Researchers for ActiveHealth Management evaluated the cost impact of ActiveHealth's clinical decision support tool, the CareEngine® system. The CareEngine clinical decision support system compares the most up-to-date, evidence-based clinical guidelines to an individual patient's data in order to identify clinical interventions and issue clinical recommendations – called Care Considerations -- spanning a wide range of disease categories. In the study, each patient was randomized either to the intervention group – the group that would receive Care Considerations – or the control group – those for whom Care Considerations were identified, but not communicated.
Underscoring the potential danger of a paper-based medical system with no measure of "checks and balances," the study identified 46 potentially serious medical errors per 1,000 persons – nearly one for every 20 members. The study demonstrated 19% fewer hospitalizations, and an $817 annual reduction in paid claims, in the intervention group – versus the control group – among those who triggered Care Considerations. There was also a 42% higher compliance rate in the intervention group with the standards of care addressed by the system's recommendations to add new medications to the patient's regimen.
"What's important is that while our government continues to support the adoption of electronic medical records, this study shows the headway that can be made even in advance of the national adoption of health information technology in physician offices." said Jonathan Javitt, MD, MPH, Senior Fellow of the Potomac Institute for Policy Studies, scientific advisor to ActiveHealth and lead study investigator. "Once electronic health records become more widespread, systems such as this will sit on top of those records and generate evidence-based recommendations in real time. Physicians need to be able to review patient data in the context of the latest, evidenced-based standards of care – clinical decision support tools like the CareEngine does just that."
The CareEngine System
Designed to improve care, while reducing costs, the CareEngine system is the ActiveHealth patented state-of-the-art technology platform that works by creating a virtual medical record from health plan claims data, drug claims data and lab test results. The system continually compares this patient data to the latest evidence-based medicine and standards of care, to identify treatment opportunities for those most at risk. These opportunities or suggestions - called Care Considerations - are then communicated to the treating physician with the goal of improving the patient's health.
"The CareEngine represents the ultimate marriage between evidence-based medical knowledge, information technology and medical data," said Lonny Reisman, MD, CEO of ActiveHealth Management. "This study shows what almost 8 million other patients who benefit from the CareEngine have already experienced – better care at reduced cost."
About ActiveHealth Management
Founded in 1998, ActiveHealth Management is a technology-driven health management and data analytics company that helps health plans and self-insured employers take full advantage of evidence-based medical knowledge to improve patient care and reduce healthcare costs. Leveraging its patented CareEngine platform, the company combines clinical expertise with innovative medical information technology to enable doctors and patients to work together to reduce medical errors, improve patient safety, improve overall health outcomes and reduce costs.
The ActiveHealth suite of services is designed to seamlessly integrate with insurers' existing care management systems. Services include URAC-accredited disease management, utilization management and case management services in addition to clinical predictive modeling, performance measures and data analytics through HDMS--Health Data Management Solutions, a wholly owned ActiveHealth subsidiary. The company's unique approach to physician and member engagement enables it to communicate treatment improvement opportunities in time to avoid serious and costly adverse clinical events. ActiveHealth is based in New York City and employs more than 220 people. The company has additional offices in Chantilly, Virginia; Chicago, Illinois and Cleveland, Ohio.
Journal
The American Journal of Managed Care