Background
The COVID-19 pandemic exacerbated existing health and social disparities, leading to unequal access to care and disproportionate impacts on marginalized community members. Simultaneously, healthcare costs have soared, straining resources and intensifying the financial burden on both providers and payers. Furthermore, healthcare providers and community clinics are under increasing pressure to leverage unprecedented volumes of health data—often scattered across disparate systems—to manage risk and optimize value-based care, especially for Medicaid and Medicare populations.
In response to these challenges, Waianae Coast Comprehensive Health Center (WCCHC), a prominent Community Health Clinic (CHC) in Hawaii, partnered with Foresight Health Solutions (FHS) to implement Caliper, an advanced AI-enabled analytics suite developed by FHS. Caliper was designed to accurately predict risk and guide care management within a value-based contract and reimbursement model.
About Waianae Coast Comprehensive Health Center
WCCHC is a pioneering non-profit organization committed to improving population health and reducing health inequalities within the communities it serves. As the largest CHC in Hawaii, WCCHC has played a leading role nationally in recognizing the profound influence of social determinants of health (SDoH) on both disparities and healthcare costs. Its early adoption of PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences) underscores its mission to deliver innovative, accessible, and affordable care rooted in a deep understanding of social and clinical risk factors.
About Foresight Health Solutions
FHS is a healthcare analytics company with over 25 years of experience in risk management, managed care, and AI-driven analytics. FHS is the developer of Caliper, its flagship analytics platform designed to empower care teams and health center leadership with actionable, data-driven insights. Through Caliper, FHS delivers cutting-edge predictive and prescriptive analytics—especially tailored to the needs of socially vulnerable populations—supporting value-based care models and improving quality outcomes.
Caliper Risk Management Solution
Caliper was deployed by WCCHC to address the complex interplay of clinical morbidity, demographic data, and SDoH. The solution’s primary aim was to predict future healthcare costs and care complexities among vulnerable populations, while delivering prescriptive insights on the most effective care services to mitigate those risks. Key components of the Caliper solution included:
- Predictive Risk Scoring and Stratification: Quantifies patient-level risk of adverse outcomes and costs by incorporating clinical, demographic, and SDoH data.
- Prescriptive Analytics for Care Management Interventions: Identifies which community clinic interventions reduce risk and calculates their ROI.
- Natural Language Processing (NLP) of EMR Notes: Enhances the identification of high-risk patients by analyzing unstructured text in staff notes.
- Geospatial Analytics and Mapping: Enables spatial and temporal analysis of health risk factors, guiding strategic community-level interventions.
Analytics Implementation Process
Caliper was implemented through a multi-step process, beginning with the aggregation of EHR, claims, service utilization, cost data, and care manager notes over a four-year span. This data was fed into a neural network-based AI model that delivered cost prediction accuracy within 6.9% of observed outcomes—outperforming existing models for Medicaid and dual-eligible populations. The implementation also included NLP-based identification of high-risk patients from unstructured notes, improving detection rates by 40%.
The insights generated enabled WCCHC leadership to negotiate value-based contracts with two major health plans in Hawaii. Caliper’s monthly analytics helped identify which service programs needed expansion and guided care teams with patient-level insights. This resulted in more targeted interventions, improved patient engagement, and substantial cost savings.
Results
Leveraging Caliper’s predictive and prescriptive analytics, WCCHC successfully fulfilled its first-year objectives under two value-based contracts, realizing approximately $3.5 million in net savings—a 16.4% cost reduction from baseline. These outcomes enabled the CHC to expand its value-based contracting to all four Medicaid health plans in Hawaii.
By aligning interventions to areas where Caliper revealed the greatest impact, clinic staff were able to increase both care effectiveness and operational efficiency. Moreover, Caliper’s success has prompted its expansion across a network of rural and underserved clinics throughout Hawaii—broadening access to advanced AI analytics and reinforcing the equitable distribution of care-enhancing technologies.
