Published: 11 January 2024
The long-term cost of delayed medical care during COVID-19 is unknown. But new technologies allow U.S. healthcare payers to address the medical risks lurking in seemingly healthy populations at scale for the first time. CIOs must create a strategy for rising risk to lower total care costs.
U.S. healthcare payers’ conventional approach to population health and care management is reactive and highly focused on chronic, high-cost claimants.
Identifying, engaging and managing the “rising risk” population — that is, members who are likely to become high-cost claimants or progress to a chronic disease state soon — is a better way to improve outcomes and cost-effectively increase savings.
Many payers claim to have an algorithm, program or strategy for risking risk. However, most lack truly targeted identification and engagement for maximum behavior change and outcome measurement.
Recent technologyadvancements, such as AI-powered predictive modeling, have made it possible to address
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