THE PLATFORM
Risk
Advanced risk profiling and predictive analytics to identify high-cost members before increasing plan expenses.
Predict and Prevent High-Cost Events
Our Risk Module leverages Johns Hopkins ACG grouping technology and sophisticated statistical modeling to forecast future costs and identify at-risk populations up to 12 months in advance. Transform your approach from reactive claims management to proactive risk mitigation with precision analytics.
Predictive Cost Modeling
Sophisticated statistical modeling forecasts costs across risk categories 12 months into the future before those costs are incurred. Gain complete visibility into utilization patterns as they relate to risk, cost, and patient encounters. Understand family-level cost correlations and take preventive action based on predictive insights.
High-Cost Group Identification
Instantly identify and rank individual members or groups by Medical Loss Ratio (MLR). Analyze correlations between MLR, claims paid, premiums received, profit/loss, and 12-month predicted costs. Robust drill-down capabilities reveal the types of claims being paid and where costs are being incurred for any selected time period.
Probability Profiling
Profile the statistical probability of individuals and groups to experience adverse, cost-related outcomes. Identify members likely to be readmitted within 30 days of discharge, predict hospital admissions, and flag high-risk cases requiring intervention. Target care management resources to the members who need them most.
OUR PARTNERSHIPs
Johns Hopkins AGC Technology
Our Risk Module leverages the highly regarded Johns Hopkins ACG® (Adjusted Clinical Groups) clinical grouping methodology, the gold standard in healthcare risk stratification developed at Johns Hopkins University. This sophisticated technology classifies patients into Healthy, Low, Moderate, High, and Very High risk categories while providing comprehensive, patient-specific predictive risk profiles that forecast future health status and costs. The ACG methodology enables precise identification of members at risk for adverse outcomes such as 30-day hospital readmissions, extended hospitalizations, ICU admissions, and persistent high healthcare resource utilization—empowering you to identify case management resources where they'll have the greatest impact on both health outcomes and cost containment.
Don’t take it from us – listen to our customers
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