Just how do you predict future claims? Is it possible to more accurately predict future health cost and utilization levels? How do you choose a vendor? How to you implement effectively?
For health plans to succeed long term, it is critical that they identify and monitor groups with unusual utilization and cost patterns (i.e., high or low) and reflect it in renewal underwriting processes and internal experience reporting methodologies. In addition, suspect groups should be reviewed for potential for other programs which could improve the near and long term outlook (i.e., disease management, case management, etc.). Health plans need to take advantage of the apparent one-time early-adopter financial advantage in addition to improving business management processes.
How can AHP help?
• Assess your current underwriting and medical management predictive performance, your systems and expected needs
• Present predictive modeling options including vendor choices and product information
• Assist in the selection and license of best model for your organization
• Install and help implement selected model
• Implement selected model into underwriting process in seamless fashion
• Implement selected model into medical management process
• Provide ongoing direction and support as needed
Why Axene Health Partners?
To be the most effective, Predictive Modeling should be implemented in both underwriting and medical management. It needs to seamlessly integrate with your information systems infrastructure. Axene Health Partners, LLC is built on the integrated discipline approach. Our consultants include actuaries, clinicians, management consultants and IT professionals to provide the best possible resource for our client’s diverse needs. We have current experience with most, if not all, of the major predictive modeling vendors. We understand their methodology, data use, software integration, sales process, product availability, HIPAA compliance, current client use and the cost to the client. Our integrated consulting approach provides the expertise necessary to understand your organization and choose a vendor and product that is right for you.