Guilty pleasure admitted, I watch Top Chef, and actually like it. By no means am I am an adventurous foodie, but I am intrigued by the dexterity it takes to balance imperfect, varying ingredients and how they will be received differently by each judge’s palate. Healthcare is a Quickfire Challenge every day. Actuaries slice and dice data and weigh carefully to perfectly cook an algorithm that is a constantly moving quotient. Think for a moment about all the variables the actuaries have to cook with:
|
Clinical Diagnoses, Behavioral Health, Special Needs |
Potential Physical Limitations |
Social Determinants |
Utilization/Claims Data |
Clinician Input (Personal Knowledge) |
|
– Any chronic disease, particularly one that is not in control or at desired goal – Chronic pain – Substance abuse (alcohol/drug/tobacco) – Terminal illness – Advanced age with frailty – Multiple co-morbidities – Pre-term delivery of newborn – Child, youth, or adult with special needs – Anxiety, schizophrenia, bipolar, depression, or other behavior affecting health – Dental health – Dementia/Alzheimer’s disease |
– Non-ambulatory – Needs Assistance with Activities of Daily Living (ADLs) – Severely diminished functional status – Declining eyesight – Extreme weakness or fatigue – At risk for falls |
– Lack of financial or family support that impacts care – Unemployed – No health insurance – Low health literacy – Unsafe home environment – Homeless – Lives alone and needs assistance with ADLs – Transportation for health care appointments is difficult – Language barriers |
– Frequent hospitalizations (particularly heart failure, GI disorders, and pneumonia) – Frequent office, ER, or urgent care visits – Multiple providers – Hospital readmission within 30 days – Major procedure in last year – Chronic kidney disease – Brain trauma – Expensive medications |
– Polypharmacy – Patient is taking several medications that may not all be needed and/or could have potential for interactions – High-risk medications – Non-compliant with treatment plan – Confusion with medications or following the treatment plan – Recent move to long-term facility or other transition of care – Spouse (who was the caregiver) recently deceased – Lack of engagement in care plan – Low confidence or ability for self-management
|
Actuaries, you rock.
“When the water starts to boil, it is foolish to turn off the heat” – Nelson Mandela
Healthideation.org 