PREDICTING HIGH COST CASES
project name

PREDICTING HIGH COST CASES

description

RESULT – Predictive Model Enables Client to Understand Risky Disease Interactions and Anticipate High Cost Cases
Predicting High Cost Cases Using Medical Claims

IVR System
Health Insurance
Costs
CONTEXT

Employee health insurance provider wants to understand and reduce health care costs


CHALLENGES


The client had medical and pharmacy claims history of its employee members but no mechanism to gain actionable intelligence on their high risk clusters, costs, quality and utilization of care.

TOOLS & METHODS
Quantiphi delivered a solution within four weeks that enabled the client to gain actionable intelligence on their healthcare spend based on their high risk clusters, provider network economics, variations in care costs, chronic disease management and quality of care.

Quantiphi built a predictive model in R based on a variant of CMS – HCC risk scoring methodology that enabled the client to understand risky disease interactions and anticipate high cost cases and develop care management programs to prevent costly occurrences and improve health outcomes.



RESULT – Predictive Model enables client to understand Risky Disease Interactions and Anticipate High Cost Cases

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