Risk Identification

Overview Facts

• Is Your Health Plan Identifying and Managing Risk? 
  • Do you know the true prevalence of chronic conditions and care gaps?
  • Have you got a handle on exactly what is driving your present and future costs?
  • MCM’s Risk Solutions provide the first steps to effective plan risk management.

• MEDai Predictive Modeling of Medical & Rx Claims
  • Initial 24 month retrospective analysis to establish disease prevalence, gaps in care, plan cost drivers and forecasted risk.
  • Ongoing monthly analysis of all medical and Rx claim data
  • Web Based data access for our payer partners
  • All analyses conducted by Registered Nurses and Physicians

• Personal Health Risk Assessments
  • Web-Based with instant member feedback
  • Educational links targeted to member risk
  • Registered Nurse review of results and member engagement
  • Plan summary report on preventable risk helps focus interventions and education

• Onsite Biometric Screening
  • Finger stick or venipuncture options
  • Testing for key risk factors
  • Onsite member results
  • Immediate member engagement

Program Impact

• Identify Plan Health and Cost Risks.
• Focus Education and Engagement of At-risk Members.
• Identify At-risk Members Flying Under the “Claim” Radar.
• Increased Identification of Potential High Dollar Claims