Capstone Projects

Understanding the Value of Population Health Solutions in Managing Chronic Conditions: A Case Study of Risk Manager and Diabetes

Program: Data Science Master's
Location: Tennessee (onsite)
Student: Kim Tiller

The focus of this study was to understand the value of population health solutions in managing chronic conditions such as diabetes. Change Healthcare’s Risk Manager product is a population health and analytics tool for insurance payers and provider groups. Part 1 of this study compared and analyzed data from existing customers to understand how Risk Manager diabetes populations compare to national trends. The study also compared customers by plan type (commercial, Medicaid, Medicare) to see which customers have benefited from the solution versus others who may require guidance. Another goal of the study was to gain insight into data issues that affect HEDIS quality measures. Understanding where customers have struggled in managing their populations is valuable for future product development efforts. Part 2 of the study explored more advanced analytics models using individual member data from the Risk Manager data mart. The data mart is the most powerful and flexible component of Risk Manager. Many customers use the data mart for ad hoc reporting. However, as data science becomes more prevalent in healthcare management, it is crucial to expose the possibilities of using data mining techniques and machine learning models to understand complex diseases and aid in population management. The goal of part 2 was to gain insights into data storage enhancements to support advanced modeling and showcase the capabilities of using data from the Risk Manager data mart.