Can Software Help Assess Patient Risk?

Wolters Kluwer has no affiliation with Altruista Health and does not endorse its product.

An information technology firm, Altruista Health, has created a software program that mines and sorts medical data to predict patient risk. Users of GuidingCare™ pay annual subscription fees per patient, granting Altruista access to data including health records, lab work, and bills. The provided solution is customized to the needs of the user: insurance companies may use it to identify higher-risk patients, while a hospital might use it to analyze whether a patient’s condition is likely to worsen.

Altruista was founded by Ashish Kachru, a former national director of business risk management for a large insurance company. After determining that the insurance company was losing money due to poor patient management, Kachru decided the best course of action would be to help hospitals improve at determining which patients need care. The program, which is capable of harvesting and analyzing large volumes of medical data, was created in partnership with the University of California at San Diego.

Altruista’s GuidingCare™ system is being adapted by many health plans. Affinity Health Plan, a New York nonprofit group offering coverage to 3,000 Medicaid patients, noticed a 50 percent reduction in hospital readmission rates in the first three months it used the program. Recently, Eldorado, the health insurance division of IT firm Mphasis, announced a partnership with Altruista. The partnership will offer Altruista’s technology, integrated with Eldorado’s payer platform Javelina, as part of its offerings to health-care provider.

Whether hospitals will find the software as beneficial as health plans do remains to be seen. Kachru recognized that one of the largest obstacles is integrating the system into hospital protocol and individual health care providers’ workflow. The system could be beneficial in many ways, such as alerting staff to factors that might aggravate a patient’s disease, but only if providers are able to use it in a cost- and time-efficient manner.

Analysts expect health care IT firms to experience steady growth over the next few years. As the health care mandates of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) go into effect, more providers are likely to invest in patient management technology. Whether GuidingCare™ is one of the programs to reap the benefits of PPACA remains to be seen; the system requires a large amount of medical data to work properly, but could lead to privacy concerns. The possibility of it providing alternative courses of care for a patient may prove a disincentive to health providers, particularly those with specialized knowledge. Health insurers and providers face many challenges and adjustments as the insurance mandate goes into effect. Adapting a new system from a relatively young, unproven company may prove to be more than many wish to take on.