Video MSIDE Smart Decisions – Patient Journey

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MSIDE Accelarmed: Adaptive patient-centered outcome-driven coverage and benefit design for patients with complex conditions

In this post we discuss the AccelarMed analytics platform and MSIDE Smart Decisions – products of MSIDE Solutions.

What others say about us

Market leaders have recognized our new AI-enabled market approach for value-based contracting in precision medicine and specialty drug market access. As an example, an article in Pharma Boardroom  outlining how AI can be leveraged to enable new drug marketing models for specialty drugs as well as to identify qualifying populations and measure cost savings and outcomes – has referenced our platform AccelarMed.

Outcome-driven coverage and pricing enabled by AI on combination of real world clinical and claims data and medical literature research.

“The FDA concedes that the health care community uses real-world data to support expanded coverage decisions and to develop guidelines and decision support tools for use in clinical practice.”
2021, Understanding real-world data in the real world | BioPharma Dive

To find cost, pricing, and prior authorization strategies for complex medical conditions, new approaches are needed. Static value-based models are insufficient and cannot accommodate the necessary decisions for ever-changing disease progression.

Enabled by new technologies – such as Machine Learning and generative AI companies now can find answers quickly and reliably and provide adaptive coverage throughout the patient journey, improve patient outcomes and satisfaction while preserving sustainable ROI.

Leveraging the power of AI – a combination of RWD financial analysis paired with outcome research from medical literature: 47% cost savings over 36 months for the most efficient treatment pathway discovered in real world data (RWD) accompanied by evidence for pathway effectiveness from medical literature.

As an example, MSIDE Smart Decisions AI mines real-world data from approximately 750,000 patients with rheumatoid arthritis to understand the effectiveness and efficiency of drug therapy pathways. It found that a treatment pathway involving a combination of methotrexate and sulfasalazine followed by methotrexate and etanercept had a 47% lower cost than the least cost-efficient pathway and a 34% lower cost than the most common pathway. Upon request the generative AI also found evidence from studies and articles supporting the superior effectiveness and patient outcomes of the discovered pathway, with links to supporting articles listed on PubMed.

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MSIDE Smart Decisions: the ultimate entry point to value-driven patient-centered ROI – based on patient journeys derived from a robust national data set

In this post we discuss the AccelarMed analytics platform and MSIDE Smart Decisions – products of MSIDE Solutions.

What others say about us

Market leaders have recognized our new AI-enabled market approach for value-based contracting in precision medicine and specialty drug market access. As an example, an article in Pharma Boardroom  outlining how AI can be leveraged to enable new drug marketing models for specialty drugs as well as to identify qualifying populations and measure cost savings and outcomes – has referenced our platform AccelarMed.

How to start exploring outcome-driven opportunities

  • In this post we are exploring how MSIDE Smart Decisions – the ultimate solution for ML enabled value pathways analytics – helps health plans and life science companies model value-driven patient-centered ROI.
  • MSIDE Smart Decisions is built on the flexible Big Data, Analytics and AI platform AccelarMed and aims at simplifying the entry into value-based payment modeling through data driven insights based on robust national data set.
  • Customers can harness the power of our comprehensive graph data models and machine learning algorithms to unlock valuable insights – by simply signing up and start exploring opportunities for savings and improvements in patient outcomes.

Key benefits at a glance

  1. Allows key insights about potential cost savings and ROI derived from a robust national data set.
  2. Allows customers to identify key areas of interest from patient journeys within national data set, before making the investment in building the comprehensive graph data models, ML and analytics necessary to perform the analysis on their own client data. This is especially important when it comes to relatively narrow patient cohorts which are the target group for some specialty drug regiments.
  3. Provides an important benchmark which ultimately allows customers to assess how the pathways compare between their populations and the national data set.

How it works

There are myriads of different pathways in patient journeys. As an example – patients with Rheumatoid Arthritis can receive a therapy with conventional DMARD (cDMARD) such as methotrexate or a combination of conventional DMARDs such as sulfasalazine and methotrexate. They can take those medications with different dosages, escalate or de-escalate before switching to a biologic alternative (bDMARD). Some pathways will include TNFi, other will start with selected immunosuppressants – alone or in combination with a cDMARD. The dosages and duration between switch of line of therapy will be different. In addition – factors like comorbidities, events like hospitalizations or emergency visits will have impact on the outcome of those therapies.

Finding the qualifying sub-populations – often narrow patient cohorts, identifying desirable outcome and cost efficient pathways within those cohorts is a time-consuming undertaking. Time-to-value is a key.

MSIDE Smart Decisions offers:

  • Pre-defined ML models that process millions of pathway combinations to detect those with lower and higher value. As an example of a high value pathway – certain combinations of conventional therapies followed by a switch to the more expensive biologics in combination with cDMARDs will result in lower cost PMPM over 36 months as well as longer duration before switch compared to other therapy line alternatives.
  • Intuitive visualizations that illustrate the various pathways between therapy lines, frequency of utilization of a particular pathway as well as cost efficiency. It provides intuitive visualizations of the high value and low value pathways and emphasizes those pathways detected by the machine learning models.
  • It allows for cost savings calculations from substitution of lower-value with higher-value pathways.
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MSIDE Smart Decisions: the ultimate solution for safe medication storage for pharmacies, caregivers and patients at home

In this post we discuss the AccelarMed analytics platform and MSIDE Smart Decisions – products of MSIDE Solutions.

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Benefits at a glance:

Improve patient safety and satisfaction:

    • Monitor medication storage at patient’s home – ensure that medications and infusion solutions are kept at appropriate storage locations and conditions (refrigerated or room temperature and humidity) in the convenience of the patient’s home
    • Deliver patient-tailored instructions, tips and recommendations – at the fingertips of patients and caregivers
    • Transform daily routines into engaging and enjoyable educational experiences – deliver supply recommendations, nutrition plans and food recommendations directly to the shopping list on the refrigerator door or any mobile device of patients and caregivers

Increase Productivity for your Staff

    • Reorder supplies in a timely and effective manner – give your staff and patient’s caregivers the tools to remotely monitor supplies and their storage conditions and reorder in a timely manner
    • Use AI Assistant – a GPT-3 enabled natural language processing tool trained on general data to find answers to your questions contextual to the tasks at hand (Beta)

Save costs, Increase ROI

    • Find the most efficient inventory management and medication storage whether at your facility or at patient’s home
    • Reduce waste of medications due to improper storage
    • Find opportunities for savings through optimizing treatment pathways with AI enabled analytics 
    • Simulate and evaluate the cost efficiency and effectiveness of the different treatment and supply chain pathways

Sign up for free and start modeling a patient-centered, value-driven ROI with MSIDE Smart Decisions powered by AccelarPath.

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Market leaders have long recognized our AI-enabled market approach for value-driven outcome  and ROI modeling for specialty drugs. As an example, an article in Pharma Boardroom  outlining how AI can be leveraged to enable new drug marketing models for specialty drugs as well as to identify qualifying populations and measure cost savings and outcomes – has referenced our platform AccelarMed.

Learn more about patient journey and value pathways analytics and ROI evaluations.

Customizable Advanced Analytics Platform for all Value-Based Payment Initiatives

AccelarMed: the One-Stop Platform for your Value-Based Programs

Customize and tailor the comprehensive AccelarMed BI, Advanced Analytics and AI platform to the specific requirements of the CMS Advanced Alternative Payment models, Commercial as well as Medicaid Managed Care Value Based Programs. Use the comprehensive Self-Service capabilities for focused analysis and rapid identification of improvement interventions to ensure, that all Value-Based Programs are on track across the enterprise service lines as well as all involved provider partners.

An End-to-End solution with Best Practices Dashboards and Reports for a unified view on all your Value-Based Programs

AccelarMed is an end-to-end BI and Analytics solution for the entire life cycle of  your Value-Based Programs:

Identify Opportunity for new Value-Based Contracts based on comprehensive actionable insights on total and/or episodic cost of care, reimbursement, quality, variation patterns, provider partnerships and referral patterns. Organizations can easily identify patient populations and/or episodes with high treatment cost, low quality and unwarranted variations in cost and utilization. These areas are typically regarded as not-profitable by payers and represent high risk for the business model of care delivery organizations. These areas represent opportunity for care redesign and achieving a sustainable reimbursement model from payer and provider perspective.

Define Cost, Efficiency and Quality Targets:

  • Identify feasible cost and quality thresholds using the AccelarMed “Best Practices” Dashboards and Reports and actionable insights into cost, quality and utilization, unwarranted variations of services across the enterprise business lines and compared to selected benchmarks.
  • Advanced machine learning algorithms with flexible configuration capabilities to proactively identify high-cost patient cohorts and tailor the analysis to the specifics of the particular served population.
  • State of the art risk analysis algorithms based on the CMS HCC, CMS RxHCC, the ESRD/PACE, HHS-HCC, Charlson-Deyo Risk, Readmission and LOS risk

Measure Outcomes and Monitor Performance:

  • Ongoing monitoring and tracking of key financial, quality and utilization metrics against the defined targets – on a monthly, quarterly and yearly basis
  • Interactive Dashboards with intuitive color coding to easily identify “high performing, best practices” as well as “low performing, with high potential for improvement” providers
  • Actionable insights into cost, quality and utilization, unwarranted variations of services compared to selected benchmarks with a high level of granularity across the enterprise service lines, geographic areas, facilities, provider groups and individual providers
  • Ability to compare performance of the various Value-Based Programs across the enterprise business lines and participating providers and intuitive overview over profitability of the various Value-Based Programs

Design improvement initiatives:

AccelarMed offers sophisticated data exploration and “what-if” analytics tools to identify and evaluate various interventions and simulate their expected impact on the overall performance and bottom line of your organization, such as:

  • Evaluate impact of potential changes in referral pattern on overall reimbursement, shared savings and bonus
  • Evaluate impact on quality improvement on the various Value-Based Programs
  • What-if analysis on the impact of reductions in utilization on the overall reimbursement and margins
  • What-if analysis on the impact of outsourcing of certain services on selected high performing provider partners and many more.
Highly customizable Platform with extensive Self-Service Capabilities for maximum flexibility

In addition to the standard out-of-the box Interactive Dashboards, AccelarMed allows business analysts to:

  • Ability to easily customize the available interactive dashboards and reports to the particular requirements of the Value-Based Programs – total cost of care or episode based
  • Configure Scorecards for provider performance to define performance categories and hierarchies such as
    • Clinical Performance (“Acute Care Quality”, “Quality in Outpatient Settings”, “Quality in Professional Settings”, “Transitional Care Quality”) and
    • Financial Performance (e.g. Clinical Operations, Partner Value, Utilization)
  •  Use comprehensive Self-Service Capabilities for deep-dive analysis and creation of custom Dashboards and Reports

Advanced Analytics and AI for Value-Based Contracting

Advanced Analytics for Value Based Care

In today’s rapidly changing healthcare landscape, payers and providers are moving away from fee-for-service to new models of Value-Based Reimbursement and Care Delivery . This shift requires proven models to systematically improve outcomes while reducing cost across the continuum of care.

The Mside AccelarMed is a flexible Big Data, Analytics and AI platform that fosters operational excellence, value based performance and reimbursement optimization. It leverages comprehensive quality and financial analytics combined with advanced machine learning algorithms and enables payers and providers to collaboratively design sustainable payment and care delivery models through planning, monitoring and proactively managing various Value-Based programs.

Key Goals and Objectives of the Innovative Care Delivery Organization

In Value-Based Contracting models, reimbursement is tied to the provider’s performance on cost efficiency and quality performance measures. It can be associated with meeting specific performance criteria or negotiated through “shared savings/shared risk” contracts. For providers it requires the deep understanding and effective planning, negotiating and monitoring of the three components – quality, reimbursement and cost – utilizing data-driven, fact-based approaches.

Quality: maintaining or improving quality is a key element for successful alignment of financial incentives such as bonus and shared savings payments
Payment: typically value based payment models require reduction of total payments for the care of selected patient populations
Cost: providers need to find effective methods to redesign care delivery to reduce cost while ensuring sustainable revenue margins

AccelarMed was conceived and designed by clinical, financial and technology experts to help Innovative Care Delivery Organizations provide the best possible and highly individualized care while accurately managing value across service lines by improving the ratio of patient outcomes achieved per dollar expended.

Data Driven Optimization of Performance, Operations Excellence and Reimbursement

AccelarMed platform offers following unique advantages:

  • Enables providers to apply a data driven and advanced analytics approaches to identify paths to sustainability for innovative Value-Based contracts and care delivery programs
  • Provides advanced capabilities to evaluate and manage key aspects of managing the Value-Based Contract as well as delivering high value services and redesigning healthcare delivery options

Value-Based Program Management
AccelarMed provides the advanced algorithms, interactive and intuitive dashboards and reports to manage various value-based programs:

  • Identify opportunities for Value-Based Programs,
  • Set quality, cost and utilization targets,
  • Monitor actual-to-budget performance across the various enterprise service lines,
  • Design the provider network – identify opportunities for partnerships, acquisitions and outsourcing models

Learn more about the comprehensive AccelarMed Value-Based Program Management features.

Proactive recognition of patient-cohorts within the served population that require special Value-Based Modelling and Care Delivery using the AccelarMed AI and advanced machine learning models

Driving growth in Value-Based Care environment requires tailoring quality, reimbursement and cost targets to the specifics of the various Value-Based Contracts and the served populations leveraging big data, real-time analytics with artificial intelligence (AI) and machine learning models.

AccelarMed helps identify well defined population cohorts with specific clinical characteristics, utilization and cost patterns using:

  •  State of the art risk analysis algorithms based on the CMS HCC, CMS RxHCC, the ESRD/PACE, HHS-HCC, Charlson-Deyo Risk, Readmission and LOS risk
  •  Advanced machine learning models with flexible configuration capabilities: A core component of the AccelarMed AI platform includes the machine learning models for patient cohort analysis. The advanced ML algorithms can identify specific cohorts of the served patient population based on prevalent co-morbidity combinations (such as   “ESRD and Other Endocrine and Metabolic Disorders”, “COPD, CHF and Arrhythmia” or  “Pneumonia, Pressure Ulcer”), the patient risk profiles as well as common patterns for utilization of services/ pharmaceutical products. 

The AccelarMed Dashboards and Reports provide actionable insights about cost, quality and utilization, unwarranted variations of services for these patient cohorts with a high level of granularity and across the enterprise service lines. The detailed analysis enables organizations to design sustainable Value Based Contracts and Care Delivery Models with appropriate cost thresholds and quality goals tailored to the specific needs of the identified patient sub-population.

Network Optimization
AccelarMed offers a deep-dive performance analysis across integrated service lines, in- and out-of-network providers with the out-of-the-box capabilities for:

  • Break-down of cost, utilization and quality metrics per individual provider, practice, site, division and service line,
  • Answering key questions such as:  “what is the typical service utilization for a particular population group”,  “who are the providers with high quality and high efficiency that can help drive down the cost while improving overall outcome” or  “what is the performance of providers across the enterprise organizational structures compared to the average in the state”,
  • Leveraging proprietary and public data, AccelarMed augments the performance information about in- and out-of-network providers to enable new partnerships that foster quality and efficiency improvements,
  • Optimize provider performance and identify virtual teams for patients in specific narrow cohorts – e.g. after leveraging the machine learning models to identify high-risk patient cohorts in the served population (e.g. in the narrow patient cohort of “COPD, CHF and Arrhytmia”), organizations can identify the providers with best quality, efficiency and patient satisfaction performance as well as “best virtual teams” across service lines (inpatient, outpatient, professional).

Quality and Patient Safety 
AccelarMed provides following comprehensive features:

  • Allows providers to measure quality and patient safety indicators across enterprise service lines, specialties and various Value Based Payment Programs by leveraging over 200 best practices quality and patient safety indicators endorsed by NQF, AHRQ and various medical societies and used in MIPS, PQRS and other quality programs
  • Offers intuitive tools to customize existing or create new quality metrics
  • Provides the possibilities to set targets, track and monitor actual-to-target development
  • Configure actionable alerts when indicators fall short on certain predefined thresholds
  • Insight into specific quality performance for the patient cohorts identified through our powerful machine learning algorithms

Reduction of Unwarranted Variations 
AccelarMed provides the tools to gain deep insights into the root-cause for unwarranted variations, define new targets to support informed decisions and the definition of meaningful improvement initiatives. AccelarMed provides out-of-the box capabilities to measure:

  • Cost Related Variations: due to price differences, utilization of services, different sites of service (Inpatient, Outpatient, Professional or Emergency room) resulting in different costs for comparable procedures
  • Quality Related Variations: such as per geographic distribution (by ZIP code), health plans and health plan type (e.g. Medicaid, Medicare/MA, Commercial), health plans

The variation analysis can be performed for the entire patient populations or refined based on the identified narrow patient cohorts using the Mside AccelarMed machine learning models.

Effective ABC Costing and Reduction of Workflow Waste
AccelarMed provides the capability to use flexible Time-Driven Activity Based Costing to:

  • Track expenses at a very detailed patient level
  • Identify sources of unwarranted variations
  • Identify easily areas with potential for improvement such as finding and removing bottlenecks or intermediaries in processes, moving process steps in the system closer together, do tasks in parallel and many more