Moving from Behind the 8-Ball

Capturing the Magic of Analytics

Without a doubt.

The insurance industry has historically peered into a tiny window of information generated by claims experience to predict risk (and cost!) and steer members into fairly standardized care management programs.

But that approach has limitations. Much like that over-sized billiard ball toy we’ve all consulted, there are only so many solutions available — no matter how many times or how vigorously you shake up your claims data.

This one-size-fits-all approach has proven to be minimally effective at increasing engagement, lowering health risks and reducing cost. Is that really what members and employers expect from us?

Don’t count on it.

Health care has always been personal, yet systems and processes traditionally center around the needs of the health care system rather than the people we serve. So we decided to stir things up by listening to our members, capturing their preferences and combining critical member-generated data that is ignored by other carriers. We create a digital footprint for each member that reflects his or her unique qualities and preferences. From there, we can chart a unique, clear path for the member to follow. For example, not all diabetics are alike, and they should not be treated the same — nor do they want to be.

By capturing the unique qualities, characteristics and preferences that ultimately generate a human’s health condition, we can deliver a first-class and effective experience for our members. It also allows us to deliver an efficient, precise and connected solution based on the specific objectives and cost drivers for employers. Is it working?

Signs point to yes.

Just take a look at our game-changing Precision Care Solutions. It’s the engine that drives this unprecedented experience for our members and clients. Instead of a traditional broad-brush approach to delivering health improvement programs, we target the issues driving costs in a specific population and then deliver them the way that member wants to receive them.

Precision Care Solutions is powered by advanced data analytics and predictive modeling using health plan data, information supplied by members and their providers, social determinants of health, data integrated from vendor partners (e.g., lab values), and many more data assets. Our system provides active surveillance of this information to proactively identify and deliver specific interventions — whether it’s helping a member find an affordable alternative to a costly prescription medication, assisting with transportation issues or connecting the member to community resources.

Our advanced analytics and predictive modeling are only as effective as the interventions and the delivery mechanism aimed at answering a member’s health concerns. So we’ve also built advanced and flexible solutions for the top high-cost chronic and acute conditions to ensure our employer groups can deliver immediate results to the bottom line. Our integrated suite of programs address both medical and behavioral health while helping members solve for social determinants of health to reduce barriers to behavior change. Our innovative programming and multiple modalities, including digital, telephonic and in person, have driven unprecedented engagement and outcomes. These outcomes have been certified by the Validation Institute to deliver a rate of events per 1,000 vastly below the market.

With our proprietary clinical analytics and predictive modeling solutions, we can help you find the magic in managing and marrying your data with that of more than 29 million members to uncover customer-centric and cost-saving solutions. You can rely on us to help you answer the question, “What’s next?” instead of “What just happened?”

Our response?

Outlook good!

More Insights

Get so much more than a TPA.

Reach out to learn more about the power of National Alliance.