Identify and Manage Population and Network Risk

Identifying and Managing Population Risk

Health plans and insurers have always faced pressure to control costs, manage risk and improve quality of care. Today, new value-based healthcare delivery models are increasing the need to measure provider performance and measure population health. Sick members create greater risk and higher costs. Profitable risk management by healthcare payers with plans serving diverse patient populations requires an actionable insight into population risk and a forward-thinking approach to patient care and network management.

Segmenting Populations with Healthcare Predictive Analytics

You can only manage what you can measure. Healthcare predictive analytics can help segment plan members and forecast future costs of care for each population. Actionable insight gained through predictive analytics can help drive care management programs, increase efficiency and improve healthcare outcomes, reducing unnecessary medical spend.

Predicting Likelihood of Hospitalization and Taking Steps to Reduce Admissions

Predicting hospital admissions and preventing readmissions allows you to optimize margins while improving medical spend. In addition, healthcare predictive analytics can allow you to stratify populations and identify specific very high risk and high-risk individuals who are most likely to incur costs for admissions and readmissions – and benefit from care interventions to reduce their risk of hospitalization.

Identify and Manage High-Risk Members with Aggregated Population Health Data

McKesson can bring together healthcare data from many sources – such as paid medical claims and pharmacy – into a single, comprehensive data warehouse. Payers can aggregate this data and share information across the care continuum to more effectively manage high-risk members. In addition, data analytics can help you uncover costly population health patterns, such as members seeking primary care in high-cost settings and costly drug spend patterns.

Gaining Visibility into Populations

Population health management can help you get visibility into the effectiveness of your healthcare spend at the member, employer group, provider and provider group level – across one or multiple lines of business. Learn how McKesson Risk Manager™ can provide payers with the visibility and actionable insight to understand population risk and make changes to lower it.

Next: Align Providers with Plan Goals