Applications for Health Plans
The Archimedes Model enables healthcare decision makers to get a more accurate picture of the likely future outcomes of the choices they face, so that they can make more informed decisions and thereby find ways to improve quality and control costs. Traditional methods for making decisions in health plans are severely strained by the rapid pace of medical science, the number of variables to be considered, and the lack of good information. As a consequence, is it very difficult for decision makers to anticipate accurately the effects of the choices they face. This hurts both quality and cost.
The Archimedes Model was built to help resolve that problem. It was initially designed for one of the largest and most advanced health plans to help its executives, managers, and providers understand more clearly the effects of their decisions and enable them to find the most efficient and least expensive ways to provide high quality care.
The Model can be used to answer questions about the effects of interventions on both populations and individuals. For example, at the population level the Model can be used to analyze the effects on costs and outcomes of new guidelines, changes in treatment goals, new technologies, disease management programs, performance measures, or incentives to improve performance and compliance. These can be analyzed for entire populations, specific risk groups, commercial or Medicare populations, or particular employers and accounts. At the individual level the Model can be used to prioritize patients and treatments for physicians, care managers, disease management, outreach programs and incentives.
Specific examples of applications include:
- Identifying members who will benefit most, in terms of decreased risk, from an intervention or set of interventions
- Understanding how much can be spent to identify people who can benefit most from treatment while still generating savings
- Determining the trade-offs between the costs and effectiveness of different choices of drugs, devises, or procedures
- Structuring co-payment for specific drugs
- Evaluating drugs for inclusion in formularies
- Comparing the effectiveness of two or more interventions
- Forecasting effects of demographic changes on future costs
- Determining appropriate incentives to encourage patients to participate in wellness initiatives, to make such programs cost effective
- Aligning incentives in programs such as "pay for performance" to match more precisely the expected effects on quality and costs
- Designing the content of Patient-Centered Medical Home initiatives to optimize outcomes and costs
The Archimedes Model can help you: