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New York, NY, October 14, 2003
With only so much money to spend on ever-more-expensive medical procedures, drugs, technologies, and tests, where will such spending do the most good? This question bedevils the health care world, but researchers at Lotter Actuarial Partners, a New York actuarial consulting firm, have come up with an award-winning approach.
“The Holy Grail is to identify people who will cost the health care system a lot of money, then intervene to prevent problems and reduce expenses,” explains Ian Duncan, a partner and risk management/risk prediction expert at Lotter Actuarial. Duncan is lead author of a paper which just won the prestigious Disease Management Association of America award for best article of the year on management of chronic illness.
Insurers know a lot about patient behavior that physicians and hospitals don’t know. “Your doctor gives you a prescription,” says Duncan. “But your insurer knows whether or not you have filled it .” Patient noncompliance is a major cost factor in chronic illnesses, which account for as much as half of a health plan’s soaring expenses.
Health plans already know all about high-utilizing patients. Duncan and two colleagues, Henry Dove, Ph.D. and Arthur Robb, Ph.D., used claims information to identify “sleepers” who had not yet required expensive care but were likely to do so within six months to a year.
“Our approach applies techniques from direct marketing. Marketers target those who are most likely to respond to their message,” notes Duncan. “We identified patients who were most likely to have an expensive event, such as a hospital admission. Helping patients like that would save needless suffering and a lot of money that could go to help others.”
The award was announced October 13 in Chicago at the Disease Management Association of America’s annual meeting. The paper, “A Prediction Model for Targeting Low-Cost, High-Risk Members of Managed Care Organizations,” was published in the May 2003 issue of The American Journal of Managed Care.
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Lotter Actuarial Partners is an actuarial consulting firm specializing in risk management, risk prediction (including predictive modeling), and reinsurance brokerage, with a practice in disease management and health risk prediction.
To conduct a media interview with Mr. Duncan, email iduncan@lotteract.com, call 212-532-6433, or visit Lotter Actuarial’s website at
www.lotteract.com.
The Disease Management Association of America is a nonprofit, voluntary membership organization, founded in March of 1999, which represents all aspects of the disease management community. For more information, please visit
www.dmaa.org.
The American Journal of Managed Care publishes high-quality clinically-focused manuscripts that emphasize health care outcomes, clinical- and cost-effectiveness, new technologies, quality management and clinical information systems, physician and patient behavior, and health policy. Published monthly, the journal has a circulation of 52,000. For more information, please visit
www.ajmc.com/.. |
