Client Story

Leading Insurance Company Reduces High-Risk Population Expenditure

Overview

A leading US health insurance company sought to reduce expenditure on their high-risk populations.  They required a solution that would enable them to identify high-risk populations and deliver targeted care coordination programs that are proven to decrease risk and reduce expenditure.

Solution

Using our cutting edge analytics software Smart Test Technology®, and predictive analytics techniques and approaches, Lumina Datamatics helped the client determine the target population and tailor content to fit the population’s needs.

  • Analyzed claim forms, statistically determined individuals who had a higher likelihood of a major health event in the next twelve months, and then recommended their participation in the internet health program with phone coach
  • Measured the target population’s web and voice interactions with goal-setting, the web site, voice conversations, goal completion, and other factors to predict engagement
  • Tallied expenses on these individuals against expenses in a similar-profile control population

 

Results

Lumina Datamatics found that the program population had significantly reduced expenditure. Expected expenditures in the engagement program population went from $600 to just over $400, while the control population’s actual expenditures rose. The program was found to save $6 for every $1 invested.

  • PrePMPM Costs, Not Engaged Member 61%
  • PrePMPM Costs Engaged, Member 55%
  • DurPMPM Costs, Not Engaged Member 72%
  • DurPMPM Costs, Engaged Member 38%
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