In a recent podcast aired on Red Hot Healthcare, Chairman, President, and CEO of HMS, Bill Lucia, sat down with host Dr. Steve Ambrose to discuss HMS’s role in the healthcare system as well how HMS is working to curb fraud, waste, and abuse in the healthcare industry through the use of today’s analytics and tomorrow’s consumer engagement technology.
Founded in 1974, HMS has grown to become the largest company providing cost containment solutions which are used today by over 40 state Medicaid programs as well as hundreds of commercial plans, Medicare programs, large employers, and many at-risk provider organizations
HMS Eliza's Behavioral Analytics
In 2017, HMS invested in Eliza to better understand the current and future risk of members or patients. Understanding your members is a critical component to developing care and engagement plans which seek to improve outcomes and ultimately, reduce costs.
At the core of Eliza is behavioral analytics, a science developed by behavioral scientists that analyzes healthcare claims data and other third party data about consumers. The ultimate purpose of behavioral analytics is to gain a better understanding of how consumers want to be communicated with and find the most effective channels through which to communicate with them. This improved communication helps plans take the necessary steps to make consumers take action and become better users of the healthcare system.
Know Your Members
To really improve patient care, HMS Eliza knows it is necessary to treat the whole person. This creates the need to understand the impact of issues such as social determinants of health and an individual’s access to resources. By understanding more about your members, it becomes possible to find the best way to deliver personalized care in the right setting, at the right time.
Today, about five percent of the population cost the nation about half of all healthcare costs. Bill notes that although this number might seem scary, it is actually a major opportunity to create real change within the healthcare industry. HMS Eliza hopes to change consumer behavior and create an impact in the system by creating and using different tools. A shift in the healthcare industry has made health plans begin to focus more on the consumer rather than larger employment groups. Most provider organizations today have said that “revamping” their entire patient experience is critical and has become a top priority. HMS Eliza uses collected data, behavioral analytics, and insights to help plans gain a better understanding of their members. Plans are then able to take this information and apply it to ultimately reduce costs and improve outcomes.
An example that highlights the importance of knowing your members comes from the past hurricane season. HMS Eliza was asked by several of its health plan clients to reach out to evacuating members and let them know they were pre-approved for life-sustaining medications. Within 24 hours, HMS Eliza was able to get campaigns out to these members affected, allowing them to get the medication they needed in time. The quick and direct action taken demonstrates the focus HMS Eliza has on taking what many people commonly called population health analytics from the very macro level, down to the individual member at a personalized level.
“HMS is a 40 year old company, 2,500 people strong, leading innovatively from the head and the heart,” Bill Lucia says. He adds that he believes HMS still holds the power to be a disruptive force in the healthcare industry. Bill sees HMS playing a key role in creating a better healthcare system that every person in our nation can utilize without the fear of going bankrupt, or having to choose life necessities such as food over medication.
To learn more about HMS, view the full podcast here