US HealthCenter: Providing Options in Reducing Health Costs

Gavin Quinnies | President & CEO | US HealthCenter Inc.
Gavin Quinnies | President & CEO | US HealthCenter Inc.

US HealthCenter Inc. was founded in 2010 and is a derivative of a couple of predecessor companies founded in 2003 by Dr. Raymond Gavery, MD and Gavin Quinnies. The company’s mission is to “improve people’s health and reduce healthcare cost by providing industry-leading health management science, technology, and advocacy to prevent and manage disease”. By engaging with health plan sponsors, insurers, payers and providers to manage population health and assist participants on a highly personalized level, US HealthCenter helps to prevent surprise medical catastrophes, thereby lowering cost and improving quality of life.

US HealthCenter is the first to have a third party evaluate and validate the ability to predict risk. It is also the first to be recognized for navigating the patient to a lower risk level. As a health risk management corporation, the company’s tools and services assess health status, predict future costs, provide targeted health education and behavior improvement, and help manage employer-based onsite health services.

In an interview with CIO LOOK, Gavin Quinnies, CEO of US HealthCenter, guides us on how to reduce healthcare costs using an incentivized proactive approach, providing expertise to improve people’s health and understand healthcare delivery patterns.

Below are the highlights of the interview conducted between Gavin Quinnies and CIO LOOK:

Describe your cutting-edge healthcare solutions.

US HealthCenter is a population health and well-being organization focused on early detection of diseases. USHC’s proprietary PredictiMed™ AI driven suite predicts the likelihood of disease pre-symptomatically for over 75 conditions and lifestyles, including many cancers, metabolic, mental/nervous, autoimmune and musculoskeletal conditions. The third party validated predictive modeling solution digests data such as genetics, family history, demographics, medical and medication history, biometric, body chemistries, lifestyle, and wearable data to compile a health profile of past present and future health status. The predictive accuracy has been third party validated to reduce ER and hospital visits by 80-93%. This data then configures the Personal Health Dashboard™, the participant portal and app with personalized content to help the participant prevent and manage disease. Data is aggregated and calculates the population risk burden, or future potential spend by condition. Risk Burden, Readiness to Change, social determinants and population culture are used to customize engagement strategies that reduce risk, which lowers cost and improves quality of life.

“A complete health plan for self fund fully insured groups.”

Our Wholeistic™ Coaching model has been validated as first in class for Care Navigation, and brings all the human touch to the population either virtually or in person. Our Sweeper Claims analytics tool can measure gaps and quality, spend and trend to get a before and after look on medical expenses. The HealthCounts™ gamification engine tracks, measures, and rewards participants for personal or group engagement.

US HealthCenter has been fortunate to leverage health risk approaches to build unique health plan products that reduce cost and increase quality of life.

How will you define the term ‘disruptive venture’ and how do you justify yours as one? 

We see disruptive as changing the status quo, creating new paradigms that shift the industry. Our key contribution to this is to move from a reactive disease management approach where providers get paid to treat the sick, to a model where providers get paid to keep people healthy while linking all the employers and plan participants into a cohesive engagement model.

How do you diversify your company’s offerings to appeal to the target audience? 

We are unique in the fact that our history of AI and predictive modeling is some of the most extensive in the industry. We have been using our tools to predict and improve health since 2003, which has earned us a third-party validation by the Intel/GE Validation Institute. In February of 2015 The Institute had the TM opportunity to validate PredictiMed’s ability to identify and lower the pre-disease high risk level, which may precipitate a higher use of ER and hospital services, in thirteen major disease categories to a lower level where the preemptive intervention can be applied and thus reduce the incidence of ER visits and hospitalizations between 80 and 93%.

Additionally, we have not only been certified to have a unique ability to predict, but also an ability to steer patients towards better outcomes using our TM Wholeistic approach. This was substantiated when the company was awarded the highest level of recognition by the Validation Institute for the population health management category of “Program Provider – Care Navigation”. Care Navigation is a subdiscipline of care co-ordination that aspires to steer patients to the most appropriate and effective clinical provider which reduces or prevents disease and reduces cost. The Health Value Awards recognizes outstanding services, products, and programs across 34 categories spanning the healthcare industry.

What technologies are you leveraging to make your solutions resourceful? 

Since the inception of our model in 2003, US HealthCenter’s platform has been a SAAS cloud-based model built on the Microsoft platform. With all the power that an early adopter of web-based tech avails, we continue to evolve our toolset. Health data is disparate and challenging, especially when the sources may vary significantly. We have used neural networks and AI since their inception to continuously evolve our model and are exploring blockchain solutions where appropriate. Additionally, we have been early adopters to the mobile app world, launching our first version of our app in 2016. We also jumped on the wearable bandwagon early on and have integrated that data to help craft a picture of health for the participant.

What innovative measures have you undertaken to stay ahead of the competition? 

We continue to bring not just analysis and engagement to the Population Health and Wellbeing Industry, but also new product types and sets. In the past few years we have been helping clients manage their risk pools and create captive insurance models, launching several new self-funded health plan models. We recently TM launched our newest version, The PredictiMed Plan, a unique all-inclusive self-funded health plan design that saves traditionally 15% upfront during underwriting and reduces the large claim risk through proper participant engagement and risk reduction. It employs cost-saving tools for when health services need to be purchased.

Additionally, our personalized predictive modelling has been used to direct consumer products to the right participant for their unique health situation.

How is the company upgrading itself with the volatile technological advancement to offer disruptive products? 

Our technology focus continues to be on new software development tools, AI, and other models that leverage big data. We continue to find new ways and markets to leverage our predictive technology. A new wave of personalized medicine and prevention is demanding insight into populations like never before. Consumers want engagement that is about their personal situation. As ACOs and providers take on more risk, they need better tools to measure, manage, reduce, and take risk. Coupling these strategies with insurance products and consumer engagement methodologies to reward providers and consumers in getting and staying healthy creates cost savings for all stakeholders.

What, according to you, are the challenges in the healthcare industry? How are your solutions overcoming them? 

The healthcare industry is overly fragmented in both technology and service. For example, there are too many individual technology solutions that can’t talk to each other, and if they do, data mapping and normalization are complex and rarely well managed. This ‘piecing together’ of various technologies creates unnecessary workflow problems that interrupt care and reduce quality when care is delivered. Additionally, the cost is increased because of unneeded steps and costly data integrations. That is why we have strived to build a complete ‘womb to tomb’ solution from the participant out. Our participant-centered approach improves outcomes and quality and reduces cost while increasing participant engagement and satisfaction. The technology has to render the service usable by all parties including the participant, risk manager, clinicians, and participant experience team. We have strived to create models where the participant and provider incentives are aligned with the reduction of medical and financial risk as well as enhanced participant experience.

Being a leading healthcare analytics and intelligence provider, what has been the company’s contribution to the evolution of the healthcare industry? 

We are the first to have a third party evaluate and validate our ability to predict risk, and also the first to be recognized for navigating the patient to a lower risk level while reducing cost. This is a unique combination of analytics and engagement that is not prevalent in the industry. Additionally, we have been fortunate to be working with other forward-looking organizations that many times become our client. By utilizing a unique combination of our client’s solutions that our PredictiMed™ technology is embedded, we change the landscape.