Disease Management Analytics

Pinpointing highest risk members for impactful interventions

To mitigate costs associated with the most expensive chronic conditions, you need to know which members present the greatest risk for future utilization of healthcare services. Using proprietary algorithms adapted from nationally recognized quality measures, our clinical informatics experts analyze medical claims data from multiple sources to identify high-risk individuals and determine their likelihood of future utilization. Results enable you to create opportunities for targeted interventions and improve allocation of limited resources.

Features:

  • Assesses disease prevalence and assigns a risk score to each individual that can be broken down by service category and 1,400+ clinical classifications
  • Uncovers the most expensive and prevalent chronic conditions impacting your organization
  • Identifies members with “gaps in care” that highlight missing preventive care or recommended care services
  • Relates member compliance with evidence-based guidelines to meaningful benchmarks
  • Analyzes overuse of costly healthcare services
  • Monitors member utilization across the care continuum and reports health outcomes
  • Identifies key risk drivers and forecasts healthcare expenditures

Did you know?

Treating people with chronic diseases accounts for 86% of our nation’s health care costs.*

Employers are recognizing that early intervention and engaging employees in improving their health is vital toward improving outcomes and lowering costs.

*Source