How can HCRM Predictive Modeling Support Stop-Loss Carriers, MGUs, and Captives?
HRM Risk Measures
The HCRM model predicts clinical events and outcomes for each member of the population and attaches a dollar value to those predictions. As a result, the models accurately predict cost by clinical risk driver, pharmacy cost, emergency room visits, and days inpatient. Predictive modeling provides measures of relative risk compared to the national norm for each member. It also provides the percentile risk for being in an acute care environment (ER or IP), non-compliance with national standards of care for 19 chronic conditions, and five preventive categories of motivation to maintain or improve healthy behaviors.
STOP-LOSS
HRM predictive modeling provides stop-loss carriers and managing general underwriters (MGUs) with key information about probable shock losses and overall aggregate spending.
It also provides information on high-cost, high-risk patients in the next 12 months. This includes total cost, the amount spent on pharmacy, and identifying major clinical risk drivers and specialty pharmaceuticals.
Stop loss carriers can generate fast, accurate quotes for renewals. Additionally, with monthly reporting, the carriers can monitor planned performance and identify new shock losses before claims are incurred. This allows them to manage their clinical and financial risk effectively.
CAPTIVES
Captives provide an additional level of protection. Captive insurance programs can use HRM predictive modeling to forecast each group's pricing accurately. They can also track performance over the year by evaluating the individual employer groups within the captive and identify those running ahead of or below cost expectations.
Additionally, groups can utilize the information to engage with population health management to improve health and reduce costs. Since 85% of the cost of the health plan is claims, a claim not incurred is not a cost to the plan. Captives can better manage their overall risk by utilizing predictive modeling and accurately assessing the risk of the individual plans.
HCRM harnesses the power of the award-winning MITCH predictive modeling engine, a tool that creates a meticulous model of how health care 'works' for a specific population. No other predictive modeling comes close to the accuracy of HRM.
