Health plans typically have no data on new members. Once these members enroll, it can take up to six months to accurately identify high-risk/high-cost members.
Existing members are equally challenging. Many plans wait three months or longer from encounter to claim rationalization.
During this period, your organization has little insight into which members will drive future claims cost or compromise revenue opportunities via HCC, Stars and more.
This is your blind spot.
Let us show you how we'll eliminate it.
Speed and Efficacy Drive ROI
PrescienceRx was significantly faster identifying high/very risk members
in a study comparing a leading analytics platform using multiple data sets.
in a study comparing a leading analytics platform using multiple data sets.
At 3 months, Prescience Rx had identified
%
of very high risk individuals and 60% of high risk individuals compared to no high risk patients identified by traditional case identification methodology
At 6 months, Prescience Rx had identified
%
of very high risk individuals and 75% of high risk individuals compared to only 4% of the total patients identified by traditional case identification methodology
With 3 months of prescription data, Prescience Rx had identified
%
of inpatient, 62% of observation stays and 42% of ER visits. Of these,
77% of patients who were also CR 5 averaged 5 ER visits, and 85% of those who were Polyprescriber 5 averaged 6 ER visits