HEALTH PLANS

INSURANCE COMPANIES WITH FULLY-INSURED PLANS

Health plans can use predictive data analytics to assess clinical and cost risks, anticipate trends, and improve decision-making. HCRM’s data analytics identify individuals at risk for specific health conditions, enabling proactive strategies to save costs, mitigate risks, and prevent financial loss across their book of business and individual insured groups.

The Challenges Faced by Health Plans

In 2023, the average premium for employer-sponsored health insurance was $24,000 for family coverage, with the employer typically covering three-fourths of this cost. This marks a nearly 50% increase in the average premium over the past ten years, and these costs are still rising. Chronic illness among members plus gaps in care areis the primary drivers of these costs. Identifying these members for targeted intervention can help reduce costs, but it can be challenging as current costs do not always indicate future expenses and health events. For instance, an asthmatic member who is non-compliant with two or more standards of care is twice as likely to visit the ER as a member who is compliant with all measures.

HCRM predictive healthcare analytics uses 24 months of claims data and over 3000 health and cost measures to identify members at risk of future health crises.

How HCRM Can Help?

At HCRM, we offer access to cutting-edge AI technology with book of business group and member health analytics tailored to your specific needs so that you can better manage health plans, member health, and future costs. Our goal is to simplify the complex world of healthcare analytics for you.

Our Care Management Module seamlessly integrates with the predictive modeling system to improve member engagement and monitor long-term health outcomes. This tool, combined with our team’s training and support, is available both on-site and remotely. This valuable resource can be accessed whenever and wherever you need it. We can also help you generate customized reports and assist in interpreting the results of our prediction processing, providing valuable insights into population health analytics.

Alternatively, the HRM predictive modeling system can be integrated with existing care management software currently in use. Likewise, the system can be accessed through our SaaS report server or installed within a client’s data center, if the population size warrants.

Breaking Down Our Health Plan Analytics

At HCRM, we empower health insurance organizations with advanced data analytics previously limited to larger companies. These reports highlight data from your member base, detailing disease prevalence, yearly spending, future medical and pharmacy cost predictions, several ways of identifying risk, compliance with 128 clinical standards of care, and more. Clients can access our Health Risk Monitor system to clinically stratify a group, identify individuals for intervention, and then create custom graphs, enabling outcome reports for improved health and overall cost reductions