Predictive analytics is essential for managing medical expenses and enhancing health outcomes for health plan members. The Health Risk Monitor (HCRM) app identifies “MOVERS,” who are members expected to experience a substantial increase in costs and clinical risks. Clinical users can quickly and accurately pinpoint and categorize members based on their future healthcare expenses and clinical risks, resulting in improved health and reduced costs. This identification can lead to cost-saving opportunities by managing these members and potentially preventing catastrophic claims. The Stratification Report categorizes members based on their projected costs and clinical risks, offering a clear guide for implementing cost-containment strategies.
Cost Saving Opportunities
Another potential cost-saving opportunity is working with the catastrophic population. Around 5% of the population drives most of the health plan spending. Health Risk Monitor identifies future catastrophic members so that our clients can be sure they are being managed before claims are incurred.
Trend reporting provides outcomes of any cost containment effort, specifically focusing on catastrophic members. The following analysis from one of our clients demonstrates how this tool can effectively showcase outcomes.
Predictive Analytics and Cost Containment Analysis
This report compares an employer group to the national and regional benchmarks. This comparison identifies areas where the employer group is performing well and areas where there is room for improvement.
The employer group significantly reduced costs over two years, lowering the cost per member from $825 to $450. The group achieved this reduction by effectively working with the catastrophic population, underscoring the potential of predictive analytics in cost containment.
This graph illustrates the catastrophic population in the same employer group. (5% of the population) and how the catastrophic member’s trend compared to the employer group baseline over two years. The catastrophic members saw a reduction from $6,000 per member per month to just under $4,000, emphasizing the importance and effectiveness of working with the catastrophic population or the top 5% driving most of the spend.
NOTE: the blue “Employer Group” line below is the same as the above, but the scale has changed.
The cost per member going from $825 to $450 over 2 years and this was accomplished by working with the catastrophic population.
About Health Cost & Risk Management, LLC
Health Cost & Risk Management, LLC performs predictive modeling services and specializes in collecting and processing claims and related health plan data for Third Party Administrators, Brokers, Provider Networks, Physician Groups and other clients. HCRM provides monthly predictions of clinical events and associated costs for each member in their database. For each person, the system predicts medical costs, pharmacy costs, emergency room visits and inpatient days for the next 12-month period while also assessing compliance with national standards of care for 19 chronic diseases and four preventive categories. The information is used for disease Health Cost & Risk Management, LLC management, large case management, on-site clinics and others to address the health care needs of their members.
CONTACT US
For more information about HCRM and our data driven analytics and reporting capabilities, contact:
Kelsey Simmons
[email protected]
(574) 377-4283
