The rapidly changing environment of the US health care system, alongside increasing health care costs and a commitment to keep premiums low, requires that health insurance companies are able to capitalize on the wealth of information available to them. In addition, the impact of the Health Information Technology Investment Act (HITECH) and the implications of the Patient Protection and Affordable Care Act, are that payers must optimize their use of information in order to remain competitive in a constantly evolving market.

Matrix Knowledge Group, in partnership with Optimity Advisors, worked with a health insurance company providing national coverage to federal employees, to develop an information strategy to support the Integrated Care Management Program. Matrix worked with a cross-departmental senior team to develop a future state vision for the organization that was aligned with corporate goals. We developed an actionable road map addressing issues of governance, culture, people, processes and technology. Our work will support the organization to retain a competitive edge in an uncertain business environment.

When special populations with significant and complex health needs overuse high-cost, low-volume social services, they undercut cost-effective provision of health and human services. Matrix has extensive experience supporting policy makers, payers and providers in integrating care pathways to improve service delivery for these populations while helping providers improve cost-effectiveness.

Case management is a recognized way to coordinate service delivery in health and human services. Yet, case management can be particularly challenging for special populations, such as the chronically homeless or young people leaving foster care. These populations often have multiple and concurrent needs. Matrix undertook a three-year evaluation of a 12-site pilot program that tested different models of service delivery and case management for a number of special populations.

To support the program and the evaluation, Matrix used its AspiraHub software to develop a web-based tool for evaluation and performance reporting. This ongoing project focuses on identifying best practices and determining whether a case management approach can lead to material savings for high-cost health and human services such as foster care, emergency housing, and emergency room visits.

Effective information sharing among health agencies improves the quality of the patient experience and the efficiency of the provider. Matrix’s web-based informatics provides data collation, analysis, and reporting services to local healthcare purchasers and providers. Web-based publication and collaboration systems enable stakeholders across local health partnerships to share information among organizations and healthcare settings. These informatics tools help support collaboration and communication among practitioners as services move from hospital-based to community-based settings.

Matrix’s AspiraHub software gives managers and executives of purchasing organizations (payers) online access to corporate and clinical governance dashboards and data reports to improve governance and risk management. In addition, Matrix software has been used to develop an integrated longitudinal primary care based patient record. This enables primary care physicians to proactively target specific individuals – especially those with chronic conditions – for clinical interventions.

The UK’s National Health Service has relied on Matrix throughout its modernization efforts, from the beginning of the market reforms of the 1980s to the most recent national review by Lord Darzi in 2008.

Our Rapid Evidence Assessments (REAs) have provided decision makers with extensive evidence on where and how to prioritize investments, with a particular focus on disadvantaged populations. Our reviews have identified evidence of effectiveness, and cost effectiveness, for over 40 public health interventions. These REAs use state-of-the-art economic modeling to provide concise, clear, current information to healthcare purchasers about the relative benefits of different public health interventions and to inform resource allocation decisions.