Predictive disease risk management (IRIS)

1. Predictive Disease
Risk Management

3. PRED IC T IV E D ISEA SE RISK
M A N A G EM EN T
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HRA& DISEASERISKMANAGEMENT
There is a strong market need to use self-reported data to manage the
health of a population. Claims-based assessment to prevent medical
utilization is ineffective as risks that result in medical services are unknown
till such services are rendered. As shown in Table 1, most claims-based risk
groupers do not perform well in sub-populations. The predictive power
decreases as we start applying these groupers to smaller populations as
well asto individuals.
TARGETED PREDICTIVE RISK MANAGEMENT
(PPHM) USING CAREFACETS? IRIS AND RISK
SCORING ALGORITHMS LEADS TO LOWER
MEDICAL UTILIZATION, HIGHER POPULATION
HEALTH MANAGEMENT ROI AND BETTER
QUALITY OFCARE.
In addition, even for large populations, each of the risk adjuster tools fall
short in predicting usage by medical conditions (Table 2). This is driven by
limitations of claims based approach that does not account for unknown
risks. Figure 1 illustrates the opportunity to reduce medical utilization by
different diseaseswhere past history isabsent.
While EMRs are a useful source of
data to capture the risks that can
predict future utilization, several
challenges still remain for their
wide-spread use in population
health management.
Today, self-reported Health Risk
Assessments (HRAs) are being
used by many employers to
administer wellness programs and
by payersto drive patient-provider interaction.
Figure 1
Table 2: Extract from Milliman Report
Table 1: Extract from Milliman Report

4. HRAstoday: Focuson Risk Factors,not impending utilization
There are several HRAs available. Most payers, vendors such as WebMD and
academic institutions such as University of Michigan offer them. Table 3
below lists them along with the strategic insight provided to drive population
In general, all HRAs in the market today address PHM needs by identifying risk
factors, but not the impending medical utilization caused by a combination of these
risk factors. In addition, almost none stratify patients based on the risk of developing
diseases such as cancers or differentiate between two individuals of similar risk
profiles with a greater certainty of turning diabetic or having a heart attack or stroke
in the near future.
Ineffectivenessof Wellnessor PHM programstied to existing HRAs
Traditional lifestyle or population health management programs aimed at populations
stratified using conventional risk factors yield low ROIs. However, a lifestyle or
prevention management program that is targeted using CareFacets?risk scores to
stratify the population on the basis of impending disease risk may prove more
The reason for the low ROI isthe risk-factor based stratification methodology
used by HRAs today. Not everyone with a health risk factor will develop a
disease; for example, not every smoker will develop lung cancer or every
obese person aheart attack.
Therefore, it becomes imperative for employers and other entities offering
lifestyle or population health management to stratify their population by
impendinghealthcare needs.
RAND Wellness Programs Study, which
included almost 600,000 employees at
seven employers, showed that wellness
programs are having little if any
immediate effects on the amount
employers spend on health care. While
the overall ROI was $1.50? that is, a
return of $1.50 for every dollar that the
employer invested in the program, the
returns for the individual components
differ strikingly: $3.80 for existing
disease management but only $0.50 for
lifestyle management targeted to reduce healthcare costs.
Table 3: HRA Vendors and their approach to PHM
PRED IC T IV E D ISEA SE RISK
M A N A G EM EN T
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TARGETED PREDICTIVE RISK MANAGEMENT
(PPHM) USING CAREFACETS? IRIS AND RISK
SCORING ALGORITHMS LEADS TO LOWER
MEDICAL UTILIZATION, HIGHER POPULATION
HEALTH MANAGEMENT ROI AND BETTER
QUALITY OFCARE.
Figure 2: HRA ROI (Source: RAND)

5. CAREFACETSDISEASERISKASSESSMENT(IRIS)
PRED IC T IV E D ISEA SE RISK
M A N A G EM EN T
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TARGETED PREDICTIVE RISK MANAGEMENT
(PPHM) USING CAREFACETS? IRIS AND RISK
SCORING ALGORITHMS LEADS TO LOWER
MEDICAL UTILIZATION, HIGHER POPULATION
HEALTH MANAGEMENT ROI AND BETTER
QUALITY OFCARE.
Our approach is based on objectively stratifying those who may need
high-cost medical utilization and through tailored lifestyle or prevention
strategy, to prevent or delay this occurrence. By focusing on individuals based
on potential utilization of services and not targeting all with risk factors, we
achieve ahigher ROI.
Using CareFacets' approach,
a risk-bearing entity can be
proactive to prevent heart
attacks, strokes and catch
cancers at an early stage.
Even a small-sized Accountable Care Organization that can prevent 5-10
heart attacks or strokes every year can save over $1 million/year. CareFacets
algorithms deployed on our PRiSM? platform can be integrated with provider
EMR systems or with any care-coordination platform to provide an in-depth
PHM plan.
In addition, CareFacets quantifies risks tailored for the population being cared
for. For instance, CareFacets?IRIS stratifies elderly members based on risk of
falling, fracture, osteoporosis, dementia, mental health and activities of daily
living. CareFacets carries a library of over 20 such algorithms that can provide
the critical insight needed to manage any population.
The key advantages of CareFacets? IRIS, PRiSM? , and the approach are
summarized below:
1. Targeting individuals with impending medical utilization versus
existing risk-factors that may or may not consume medical services
driveshigher ROI
2. IRISistailored for population and provider specialty
3. IRIS can be tailored to capture risk of common co-morbidities often
missed
4. The CareFacets IRIStool is highly interactive and optimizes questions
asked based on progressive risk scoring(PRS©)
5. Individuals often do not recollect accurate biometric or other medical
details that could lead to inaccurate targets using conventional HRAs.
CareFacets? IRIS incorporates multiple risk factors into a disease
score, thereby mitigating the impact of individual inaccuracies in risk
factors.

7. ABOUTCAREFACETS
CareFacets was founded by a team of software
technologists, life science and healthcare
industry experts who saw the value in a deluge
of healthcare data and the opportunity to
channel insight from this data into a better
healthcare system. Since its inception,
CareFacets has developed analytics-based
solutions to address a wide range of industry
specific challenges, resulting in analytics and
data management platforms that are built using
state-of-the-art advances in data management
and processing.
CareFacets uses data science and technology
along with deep-seated healthcare industry
knowledge to serve its healthcare payers,
providers and life sciences clients. Using its
skills and technologies, CareFacets accumulates
and analyzes a variety of healthcare data to
develop valuable and actionable insights.
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M A H ESH R.P
CH IEF TECH N O LO GY O FFICER
Mahesh RajaghattaisaHealth IT strategist and delivery leader hasimplement large scale
transformation and transition initiatives.He hasover 15 yearsof experience in healthcare
with lengthy exposure to the payer industry, Mahesh isaproblem solver and strategic
thinker with exceptional industry/consultingbackground and the proven ability to develop
and lead large programs.Mahesh has lead and managed numerousinitiativesfor the
payer industry coveringpricing,underwriting,regulatory compliance,claims,enrollment,
and Medicare operations. He hasalso managed client engagementsin IT Portfolio
Optimization,ICD-10 transformationsand Healthcare Analyticsfor provider
performance measurement,member stratification,attribution,and care management.
Mahesh holdsaBachelor of Engineeringdegree from Mysore University and aMaster of
BusinessAdministration (MBA) degree from GoizuetaBusinessSchool (Emory
University).
K RISH N A N S.V
CH IEF STRATEGY AN D RESEARCH O FFICER
Krishnan isaseasoned executive with atrack record of revenue growth,P&L
management,strategy formulation & monetization,and customer management in acareer
spanning20 years.He hasheld leadership positionsin large,global organizations.He hasa
background in technology services,health care and manufacturing/processindustriesin
companiesin S&P500 aswell asstart-ups.More recently,he washeadingthe Healthcare
and Life Sciencesbusinessof aglobal IT servicescompany.Krishnan also led business
development for aLife Sciencesanalyticsstart-up that wasacquired by aglobal IT
servicesfirm.He hasstrongexperience in developingsolutionsthat leverage Analytics,
Cloud and Social Media.Krishnan hasextensively interacted with CXO suite aswell as
board of directorsto promote business,investment plansand corporate strategies.He
graduated from Stern School of Business(NYU) with an MBA in Finance and Information
Technology and holdsaPhD in Engineeringfrom University of Rochester,NY,and aB.S.in
Engineeringfrom Indian Institute of Technology,Chennai,India.
M A DA N M O U D GA L
CEO
Madan isatechnologist and businessoperationsexecutive with 25 yearsof experience in
the healthcare technology industry.AsChief OperatingOfficer,he led the operationsof a
software technology start-up for anumber of yearsculminatingin itsacquisition by a
Fortune 500 firm.Before that he spent 14 yearsat technology consultancy,EDS(now a
part of HPCorp) in variouspositionsservingmultiple customersin the Health Care
industry.Madan graduated from New York University with an MBA in information
technology.
OURTEAM
The leadership team includes a balance of industry experts in healthcare and
technology who are advised by a board consisting of clinicians, academics and business
veterans.

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