Predictive Modeling for Beneficiary Health Management


Creating an Health Information Management Tool which takes raw clinical and claims data and uses predictive analysis software to identify future health needs and costs of the MHS population.

Use an COTS healthcare predictive model tool to identify beneficiaries who are the highest risk for high costs/low health, and who will most likely benefit from disease and case management programs

This tool would be an ideal solution for Medical/Case Management functions with the MHS. Multi-Service Market Areas and individual MTFs would have the ability to produce actionable lists of beneficiaries to target for intervention programs to improve their health and reduce healthcare costs.

It supports the Quadruple Aim (Per Capita Cost and Population Health) as it will allow for direct and effective targeting of beneficiaries who can most benefit from intervention program.

Expected Outcomes: « Reduced Per-Member Per-Year Costs
« Optimize Medical Management Interventions « Move beneficiaries from Healthcare to Health

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