Solution Brief: Member Risk Management
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Effectively identify, target, and manage patients at risk
– Identification of high-risk members now and those likely to be high-risk in the future
– Recommendation of specific intervention opportunities by population and measurement of intervention success
– Illumination of specific improvement opportunities in quality of care
– Higher quality care delivery by better understanding your members
– Lower unnecessary expenditures by more targeted care delivery
– Top-line revenue impact through identification of gaps in HCC coding and improvement opportunities in quality measures that influence payments
– Physician group that manages risk on 500K members had multiple programs to manage high-risk populations
– Current member management process included basic risk indicators which were updated infrequently and not always accurate
– Wanted better data on their members, and better predictive analytic tools to tailor their member interventions
– Enhanced their data with Clarify data assets (e.g. SBDoH) and latest data science methods to improve predictive models
– Provided precise member risk ratings with insights into underlying risk drivers
– Recommended interventions and investments based on the specific population
– ~$1M savings readmission reduction with just high-risk diabetics
– 2-3x increase in care manager productivity
– 50% increase in enrollment for end-of-life palliative care program
We know your patients.
Our large and robust database connects traditionally siloed datasets at the individual patient level. We have clinical history, claims history, purchase history, and social demographic information for 200M+ Americans.
We provide transparency.
Rather than traditional black-box ratings, we highlight specific patient risk drivers and attributes that go into the risk ratings. We peel the onion to get behind what is driving a member’s risk the most. These details on risk drivers allow care managers to prioritize ways to manage member health challenges and social influences
We enable the right action.
We link members to established interventions, improve current interventions, and recommend new interventions. We recommend outreach prioritization based on risk and likelihood to reach members and change behavior.