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1% of members account for 22% of total spend
5% account for 50%
Identify High Need High Cost (HNHC) members prospectively with 80% accuracy
- HSI’s AI-driven platform analyzes historical claims, co-morbidities, risk scores, and SDOH to identify HNHC members prospectively
- Back-test against historical data before productionizing predictions
- Prediction accuracy: Achieve 80% true-positive through HSI Analytics. Risk scores, in comparison, are poor predictors of future utilization – known to be only 20-25% accurate
Distribution of health expenditures for the U.S. population
As a Payer CFO, do you know the reasons behind medical spend changes
– what are the components and precise contribution of each component
HSI’s claim analytics helps provide insights to CFOs to get a deeper understanding of cost trends
Quantify precisely the impact of membership changes, provider rate increases, case mix changes and other variables on medical spend
Identify target areas to manage costs and bend the cost curve
As a Payer CMO, get greater insights into utilization trends and drive better outcomes
- HSI’s claim analytics gives Medical Management team insights into service level utilization and trends – normalized for reimbursement rate changes
- Identify services that are seeing above trend spike in utilization
- Derive better ROI from UM resources – better targeting and better outcomes
Clients and partners that trust our capabilities
