Identifying and engaging health plan members is like finding a needle in a haystack.
Health Plans

Finding a needle in a haystack

May 20, 2021
Identify, stratify and engage the right health plan members
President and CEO

Last month, I presented at the AWS Global Leaders Series - Machine Learning and Data & Analytics.

As I shared with the group, at Geneia, we believe the impact our work has on individuals and populations is more important than how we do our work. Telling a story about what we do makes it far easier to understand because, in healthcare, we are all patients. Most of us also are caregivers to family and friends and have had to navigate the unnecessarily complex system of care.

Let me tell you about Lucy* and Pam.

Meet Lucy

If you’re a regular Geneia blog reader, you likely are familiar with Lucy. Like far too many of us, she has metabolic syndrome or prediabetes. In fact, one in three adults or 88 million people are prediabetic, and 90 percent of prediabetics don’t know they have it.

Nearly 30 million people have diabetes. At a cost of approximately $327 billion in 2017, diabetes is one of the top eight most expensive chronic conditions.

Diabetes infographic

Not surprisingly, Lucy’s employer, Lightening Laser, and her health plan, Allegiant, are working hard to find ways to mitigate the costs and prevalence of diabetes.

Meet Pam

Pam works for Allegiant Health Plan as a care coordinator. Her job is to find members who have emerging or worsening health conditions, such as diabetes, or populations who have missed important preventive care such as mammograms or colonoscopies. To identify whom to focus on for outreach, she needs data and data-driven insights, which are Geneia’s area of expertise.

Geneia curates data

At Geneia, we curate the data. We provide out-of-the-box, curated, scientifically validated, clinically approved healthcare algorithms and predictive models to stratify the population and prioritize members for outreach.

Stratification process

Stratify the population

Geneia’s Theon® Platform uses risk scores, demographics, hundreds of clinical markers and gaps in care to identify and stratify every member of the population into one of four risk categories:

  • Healthy
  • Rising Risk
  • Chronically Ill
  • Catastrophically Ill

Identify focus areas

Next, Geneia focuses on populations such as those with prediabetes and diabetes and then narrows even further to those members most likely to develop diabetes or have complications from diabetes within the next 12 months.

Manage the population

Now, Pam, who may have started with as many as a million members, is able to find people like Lucy to offer support and engage in her health.

Identifying, stratifying and engaging the right health plan members at the right time to improve costs, engagement, satisfaction and health outcomes is like finding a needle in a haystack.

To learn more, download our health plan case study: Improving the Triple Aim: Next-Generation ID/Strat, Analytics and Engagement.

*Lucy is fictional and not intended to represent any specific person. This information is provided for illustrative purposes only.