Rightway Introduces Artificial Intelligence To Improve Care Navigation For Persons With Chronic Conditions

Personalized risk-scoring feature helps to identify active or deteriorating medical conditions in effort to connect members with the most appropriate and affordable care

Rightway, a healthcare company revolutionizing care navigation and pharmacy benefits, announced enhancements to its risk-scoring technology to more precisely identify “rising-risk” and “high-risk” members. The enhanced system analyzes each member’s entire longitudinal medical history using both proprietary machine learning algorithms and artificial intelligence developed by clinical and data science experts. The AI system enables earlier intervention and allows Rightway’s clinical staff to perform proactive outreach to members of interest sooner. This enhanced offering helps Rightway better serve its diverse member base, especially those currently utilizing care or prone to needing healthcare services for chronic and/or high-cost conditions.

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The identification of rising risk members, especially those at risk for chronic or co-morbid conditions, is paramount to lowering healthcare costs and improving outcomes. The cost of chronic disease in the United States reaches $3.7 trillion each year, amounting to approximately 19.6 percent of the country’s gross domestic product. Meanwhile, the prevalence of co-morbid conditions continues to rise as chronic conditions like obesity often accompany other conditions such as diabetes, hypertension, and pulmonary disease. Newly developed proprietary risk-scoring within Rightway’s enhanced clinical care navigation solution provides Rightway health guides with powerful insights to better identify which members may need support. Rightway’s smarter clinical navigation model triggers outreach to members of interest based on algorithmic insights in the data.

“The ability to leverage AI to help define rising risk members and intervene in addressing these care gaps is the holy grail to prevention becoming the new intervention,” said Dr. Theodore Feldman, Co-Founder and Chief Medical Officer at Rightway. “This will inevitably lead to healthier employees and lower healthcare costs, which is critical to our mission.”

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Previously, Rightway leveraged claims analytics and health assessment information to stratify members into risk levels. The deeper, more granular overview of a member’s health from the new machine learning capabilities introduces a layer of secondary data to arm Rightway’s clinical health guides with the right information at the right time to reach out to members and provide care recommendations before a member has an adverse event – ultimately helping to lower costs and improve member health and wellbeing.

“We know that proactive, targeted outreach to members of interest is key to closing undiscovered care gaps and avoiding adverse diagnoses and events,” said Daniel Feller, Ph.D., Director of Data Science at Rightway. “Over the last two years, the data science team has been laser-focused on improving our analytics capabilities to better identify members with chronic health risks. Now our health guides are equipped with an even more powerful tool to serve the members who need it most.”

Paula Bush, EVP of Advocacy Strategy and Delivery at Rightway, added: “‘Rising risk’ members rarely realize how close they are to developing a serious “high risk” condition. Now we can help them get to the most appropriate level of care as fast as possible and at the lowest cost. We proactively empower our members to advance on their healthcare journeys: educating them about their conditions, matching them to high-quality experts, providing them upfront costs, and informing them of additional health and wellness benefits available through their employer.”

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