Member Insights with Healthcare Analytics Solutions™

Robust lab data and analytics can set your plan apart by helping you identify services faster to reduce overall member costs

Our innovative and flexible Member Insights with Healthcare Analytics Solutions can help you:

UNDERSTAND disease history and future risk through test results and predictive analytics
DECREASE THE COST of care by identifying at-risk members sooner
ENGAGE MEMBERS in their care and provide the right interventions at the right time
FILL IN GAPS in care for new and existing members to improve population health

IDENTIFY specific program eligibility for new and existing members to inform care coordination strategies
DELIVER OVERALL BETTER EXPERIENCES by understanding your members’ health status and supporting them sooner, leading to higher Consumer Assessment of Healthcare Providers and Systems® (CAHPS) scores

Longitudinal patient data including up to 2 years of new member historical lab results that predates membership to your plan
Predictive member cost score that helps your teams support the right interventions, for the right patients, at the right time
Member lab data from indirect care sources (inpatient, retail locations, etc) for a more complete picture
Predictive patient-based inferred disease list that can help identify needed services earlier—critical in Chronic Kidney Disease (CKD), high-risk pregnancies, diabetes, and cancer
Highly specific prediction for CKD to provide timely interventions that can help prevent acute exacerbations and costly care
Access to comprehensive data and customized reporting when you need it
An intuitive, searchable portal to give your team the information they need to intervene earlier

60 DAYS

IS TOO LONG TO
WAIT FOR INSIGHTS

Some regional plans are challenged with member-level insight, learning about health status up to 60 days after members join.¹

Member Insights with Healthcare Analytics Solutions helps you understand members’ health status sooner to:

According to the US Renal Data System, the total medical cost for CKD in 2013 was $50.4 billion among fee-for-service Medicare patients.²

Predictive insights can
help with prioritization

MORE THAN

of plans prioritize members that need the most care, helping to drive efficiency¹

ACT EARLIER to support and inform care coordination strategies and specific program eligibility for new members
ASSESS MEMBER RISK prior to receiving the first claim
PROMOTE APPROPRIATE, guideline-based testing
SUPPORT RISK ADJUSTMENT to inform coding and disease management once a member visits his or her doctor
OPTIMIZE STARS AND/OR HEDIS^® QUALITY RATINGS quality ratings
PRIORITIZE HRA SPEND on the qualified healthcare expenses that will have the biggest impact on members

References
1. Data on file. Quest Diagnostics; 2021.
2. Golestaneh L, Alvarez PJ, Reaven NL, et al. All-cause costs increase exponentially with increased Chronic Kidney Disease stage. Am J Manag Care. 2017;23(10- Suppl):S163-S172.
https://www.ajmc.com/view/all-cause-costs-increase-exponentially-with-increased-chronic-kidney-disease-stage-article