HBI Spotlight Analytics Platform delivers a proven suite of risk management and analytics solutions giving healthcare organizations the information they need to accurately predict outcomes to improve health. Custom machine-learned predictive risk models and methods stratify diverse populations giving healthcare providers, health plans and ACOs real-time insights that empower them to predict and act.Spotlight risk models predict future utilization, cost, mortality, and disease within a population. These scores are updated in real-time using clinical data, in addition to administrative claims data, individual and community social determinant data, or other data clients make available.
What’s in it
Spotlight RTA and performance analytics are deployed in six modules. Risk modules provide a visual display of historical data, utilization and prevalence, current risk scores, risk change, geomap, demographics, payor line of business, chronic conditions and diagnoses along with a list of the individuals in the selected population allowing users to quickly go from population list level to the individual.
Population Risk Management deploys predictive risk scores, risk features, and analysis of populations who are being managed by entities at risk or share risk for the cost and quality of their care, such as plans, accountable care organizations, clinically integrated networks, health systems, employers, or their agents. Models provide probabilities of future cost, utilization, events (like AMI, stroke, suicide attempt, overdose), and progression or exacerbation of disease (like CHF, type 2 diabetes, CKD, opioid abuse).
Acute Risk Management deploys predictive risk scores, risk features, and analysis of individuals being managed in an acute encounter, including sepsis, mortality, length of stay and readmission in near real-time.
Transition Risk deploys predictive risk scores and risk features for readmission and emergency department revisit risk for individuals in or immediately after an active encounter.
Individual Risk Profiles deployed with any of the preceding risk solutions, provides a summary view of individual demographics, historical costs, utilization and diagnoses in addition to a full risk profile. Each risk score is supported by specific features and weights picked up by the models influencing each risk, informing patient / member interventions and plans.
Quality and Performance provides insights into quality, compliance and key performance indicators for organizations and their components. All measures are dependent on available data and definitions.
Revenue Risk compares historical CMS Risk Adjustment Factors to the current state and guides the user to gaps in Hierarchical Condition Category coding. Impact is shown at both the population and individual level