Undiagnosed and untreated health conditions represent a significant proportion of unexpected costs for health plans. Members that are diagnosed later, with more advanced conditions, and often because of an avoidable and expensive event, such as a preventable inpatient stay, are key drivers of avoidable costs for plans, as well as poor outcomes among members.
If these conditions were identified and effectively managed earlier, members would experience better outcomes and associated costs would be significantly lower. Our Emerging Cost Model reliably identifies members with undiagnosed conditions and impactable diagnoses, leveraging a mix of demographic, geographic, claims, provider, and non-clinical data. This goes beyond the identification of high-risk members to provide actionable insights that empower plans to engage members more effectively through tailored outreach strategies. This translates to material savings opportunities. For example, the model surfaced more than $9 million in emerging costs in a single year for one of our medium-sized health plan partners.
- Proactively identify members likely to experience emerging costs as a result of undiagnosed, untreated, or poorly managed chronic conditions
- Understand contributing demographic, clinical, geographic, and social factors to drive more effective outreach and engagement
- Engage members earlier and more effectively in care coordination and disease management, improving outcomes and reducing costs