Mine your data to target high-risk members

Because they’re at risk for the cost of care, capitated provider organizations often employ the same high-level analytics—health risk profiling, health data analysis, and predictive modeling—that are used by health plans. Despite these efforts, gaps in care persist. 

A recent study by The Segal Company—which also mines medical data to help employers work effectively with health plans to manage the health risk factors of plan participants—found that 20% of a client’s health plan costs were due to employee diabetes and hypertension, yet only 15% of diabetics who participate in the client’s health plan had received a hemoglobin A1C test during the previous year compared to the National Committee for Quality Assurance (NCQA) national average of 44%.