Medicare Population Management

Changing the Risk Trajectories for Medicare Populations

Sixty-four million people are currently enrolled in Medicare. These are vulnerable individuals with comorbidities. Conditions such as high blood pressure, high cholesterol, heart disease and diabetes are highly prevalent among Medicare beneficiaries and need to be managed proactively to prevent avoidable visits to the emergency department and readmissions. Jvion’s CORETM takes into account medical history as well as the non-medical characteristics driving risks to provide those coordinating Medicare patient care with insights into what can be done to prevent disease or help with early detection, when treatment is most effective.

Jvion’s Medicare Population Management Suite delivers:

  • Flags identifying those Medicare beneficiaries at an increased risk for an avoidable admission
  • Proactive insights to help providers and payers identify Medicare patients before they return to the emergency department
  • The ability to prevent readmissions by understanding the underlying risk factors that need to be addressed while the patient is still in the hospital and soon after discharge
  • Early indication of which Medicare patients are likely to become non-compliant with medications

Key products for Medicare Population Management include:

  • Avoidable Admission: 30/60/90 days
  • Readmission: All-Cause
  • Avoidable Admission: Diabetes
  • Readmission: Dual-Eligible
  • Avoidable ED Visit: All-Cause
  • Readmission: Post-Discharge
  • Avoidable ED Visit: CHF
  • Readmission: CHF
  • ED High Utilizers

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Featured Product

Address the Root Causes of High ED Utilization

Emergency Department (ED) overuse results in over $38B in avoidable ED expenses annually. ED high utilizers are patients who frequently cycle in and out of emergency departments and strain hospital resources as well as lower the quality of care for patients with true medical emergencies. These individuals typically suffer from multiple chronic conditions and behavioral health challenges, and come from socially vulnerable populations with limited access to primary care physicians.

The Jvion ED High Utilizer product can help manage high utilizers by identifying who would benefit from regular visits with a primary care provider as well as the socioeconomic and behavioral factors driving their ED utilization. Additionally, Jvion can identify the community-based interventions that could address high ED users’ external risk drivers. These clinical AI insights can not only improve the health of individual patients, but ease the strain on healthcare systems as well.

Who We Help

Impact Story

Care Manager Increases Effectiveness with Clinical AI Help

A veteran chronic care case manager for the Medicare Advantage Program at a health system in Cleveland was overwhelmed. Everyday she would receive lists of people to call with never enough time to get to everyone. The existing rules-based system was no better than her assessment of age, number of chronic conditions and recent ED visits or hospital stays.

The health plan then implemented Jvion, which gave her a prioritized list of patients to call, highlighted the clinical and social barriers increasing the risk for individual patients and provided recommendations for addressing those risks. With the new system, she was quickly able to find a woman who was at high risk for ER utilization over the next 3 months because she lived alone, lacked social support and had low technical fluency, CHF and diabetes. The case manager followed Jvion’s recommendations, enrolling the woman in a complex care management program. She was also able to secure her medication, which had run out, and an appointment and transportation to a local CHF clinic thereby avoiding another ED visit.

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  • Download the latest SmartFocus paper “The COVID Aftermath: Why behavioral health is the next crisis health plans should be prepared to manage” brought to you by Jvion and SmartBrief to understand why the current state of analytics leave members and health plans exposed to a behavioral health crisis.

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