Since the inception of the Affordable Care Act (ACA) and the realization that a “sicker population than expected” filled the ACA exchanges, small and large health plans are struggling with Medical Loss Ratio Reduction.
- These exchanges have created a marketplace where premiums charged are driven by competitive market dynamics without a good understanding of the risk of the potential new membership.
VitreosHealth’s Population Health Management Series to see how and why the answer lies in leveraging population health predictive risk analytics to design Perfect Care Management Interventions:
- Part 1 (Available Now) - Disease Risk-Cost Correlation, Care Management Efficiency Curves & Portfolio Efficiency Index
- Part 2 (Available Now) - Population State-of-Health Analysis & Patient Motivation Index
- Part 3 (Available Soon) - Designing the Perfect Population Health Intervention Programs when published
By leveraging predictive analytics to quickly risk stratify the new membership and develop customized proactive outreach care management programs, we improve clinical outcomes and lower the cost of care.
- Utilize analytics for “Cost Avoidance” - - identifying the high risk members at the health risk assessment stage and develop preventive and proactive care plans to avoid bad outcomes, such as hospitalizations, ER visits, etc.
- The ultimate goal of a population health program is to keep members healthy and prevent the onset or worsening of diseases.