Predictive Modeling

Predictive Modeling 2017-07-03T22:14:50+00:00

Overview Facts

  • MCM Provides our Partners the Gold-Standard in Predictive Modeling
    • Incorporate all medical & Rx claims as well as eligibility data
    • Apply eleven distinct analytical systems and overriding clinical engine to provide reliable predictions of plan and member cost, risk level, gaps in care and member engagement opportunities.
  • Initial 24 Month Retrospective Analysis of Medical and RX Claims
    • Establish your health plans baseline prevalence of chronic conditions, member gaps in care as well as what’s driving plan cost and forecasted risk.
  • Ongoing Monthly Analysis of Medical and Rx Claims
    • Identification of “at-risk” members
    • Monitor member and plan gaps in care
    • Identify disease / case management opportunities
  • Web-based Report Access for our Partners
    • High Risk Members
    • Mover Members
    • Gaps in Care
    • Comparisons to Population
    • Cost and Risk Trends over Time

Program Impact

  • Accurate, Ongoing Identification of Chronic Conditions and Care Gaps in your Plan
  • Focus Member Engagement and Plan Wellness and Prevention Initiatives on Actual Risks and Cost
  • Improved Management of High Cost, High Risk Catastrophic Conditions.