Predictive Modeling

Overview Facts

• MCM Provides our Partners the Gold-Standard in Predictive Modeling – MEDai
  • 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 new members with chronic conditions for engagement
  • Monitor member and plan gaps in care
  • Identify case management opportunities based on high cost/high risk analyses

• Web-based Report Access for our Partners
  • High Risk Members
  • Mover Members
  • Gaps in Care
  • Comparisons to MEDai 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.