Eileen Cianciolo, Prealize’s chief product officer, has spent more than 25 years in healthcare, formulating and implementing effective products and procedures that drive revenue growth, operational efficiency, and productivity for care management organizations and health plans. Here, she shares why she joined Prealize, why proactive care is so important, and how predictive analytics may be used in the future.
What excites you about Prealize?
The conversation has been happening in the industry for years now: how can we find the right person at the right time and offer them the right action? Prealize uses advanced machine learning models to answer this question up to 12 months before an event or condition shows up in the data. By continuing to feed many robust data sources into our proprietary models, the smarter they become—truly moving healthcare from reactive to proactive.
Why do you think health plans need to be more proactive, and how can Prealize help?
Right now, programs in healthcare are reactive. Often, there is no pre-existing relationship between a member and a plan. Once a member utilizes care, we attempt to quickly get to know them and get them to change their behavior. That approach doesn’t serve the member, the provider, or the payer well.
The earlier that plans can establish a relationship with members, the better the chance they can make a positive impact. Prealize has proven results identifying at-risk members up to 12 months before their diagnoses come through on claims. With that level of accuracy, plans have an astounding opportunity to change the dynamic of traditional population health management and care management programs.
"Using predictive analytics to build loyalty among
plans, patients, and providers is the future."
- Eileen Cianciolo, CPOO
Being able not only to predict but also rank and prioritize the members who need a higher level of engagement can help plans do more with their limited resources—increasing not only the capacity of existing staff, but their effectiveness.
You previously served in leadership roles at organizations including SCIO Health Analytics, StayWell, Anvita Health (now Humana), Alere (now Optum Health), and Blue Cross Blue Shield of Michigan. How will you apply that experience to your role at Prealize?
I hope to bring more forward-thinking and imagination related to how machine learning and AI can be used in the healthcare realm. I hope to advance awareness regarding how it can be used to engage patients and members sooner and effectively alter care patterns before costs escalate. I liken this role to GPS (geographic positioning system): We’ve got to truly understand where a person is in their healthcare journey, what the destination is that will help them improve their health, then use data to direct and reroute as needed.
What predictive analytics trends are you seeing?
Precision medicine, population health management, and more niche vendors are popping up everywhere and that adds complexity for health plans and members. They need to manage all those programs as well as the abrasion that can often occur across the membership because of it. If health care management and engagement is not prioritized and orchestrated, it can impact member satisfaction and health outcomes. In addition, as value-based care reimbursement continues to grow, being able to predict the risk and then proactively manage the risk in the population becomes critical.
What are your predictions for predictive analytics over the next five years?
I believe machine learning and AI will become the central source of triage for health plans—helping determine who should go into what program and when, as well as identifying who needs communication and intervention and how. Machine learning and AI will become the rule, not the exception.
Predictive analytics will also serve as a tool that plans and providers can use to retain and satisfy members, especially in Medicare Advantage. Taking the information we know about someone beyond just their claims and incorporating their preferences and past touchpoints allows the AI to do so much more. It enables a plan to best serve the member so he or she becomes a loyal customer. Using predictive analytics to build loyalty among plans, patients, and providers is the future.
Learn more about how Prealize Health transforms care from reactive to proactive.