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Pathways Engine and Care Pathways

Uncovering Population Health Insights Using Innovative Analytics

Carenet Health is committed to providing truly personalized health management support services that help drive the most appropriate and impactful interventions for every member and every population. In order to have maximum impact, it is important to target the most appropriate members based on their condition and health history, as well as their willingness to change their behavior. Our approach goes further. We focus on a whole-person, long-term view of the person’s healthcare journey.

We identify the members to target by engaging the Pathways Engine, our predictive analytics and machine learning platform. Our Pathways Engine utilizes over 600 data points to ensure we select the most appropriate members to target. We combine raw healthcare data–including medical and prescription claims, health risk assessments, biometric screenings and electronic medical record data–with additional high-value data assets that provide insight into healthcare access, health literacy and other social determinants of health (SDOH).

This has enabled us to develop comprehensive profiles with up to 1,500 clinically relevant facts for every individual in a population. The result is a deeper understanding of each person’s clinical needs, opportunities, risks, likely behaviors and receptivity to change.

The Path to Improved Health

The Pathways Engine stratifies individuals into a clinical risk stage ranging from well to critical and back to recovery. This is known as our Care Pathways framework. Every stage of the Care Pathway represents a specific point in an individual’s health and wellness journey that can benefit from tailored engagement, coaching and education strategies. Using this framework, we can assess every person’s clinical needs and long-term disease trajectory. The result is a proactive intervention strategy that focuses on delaying progression into a condition’s higher risk, higher cost stages. Additionally, this level of insight helps us to develop personalized incentives that may have the greatest motivational impact and help drive behavior change. 

Our Pathways Engine and Care Pathways framework help stratify a population based on key risk indicators, including:

  • Conditions and clinical factors
  • Gaps in care and quality
  • Likelihood of being adherent to medications
  • Likely progression across a disease trajectory
  • Possibility of incurring a hospital readmission
  • Risk of elective surgeries and other specific treatments
  • Receptivity to behavior change or modification
  • Cost predictions in the next 12 months
  • Wellness indicators, such as poor nutrition or tobacco use

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