Predictive Model tools are software applications that use claims, pharmacy and eligibility data to predict which members in a health plan are most likely to be high-risk / high-cost patients within the next 12 months.

What do Predictive Models do for your organization?

Today's health care market demands that health plans improve the quality of care, control costs, and set renewal premiums more appropriately. To be successful in any given market, a health plan must be able to assess accurately health care needs in their covered populations. The primary objective of an effective Predictive Model is to prospectively identify members within your plan who have the greatest need for medical services. Instead of reviewing member utilization patterns at random in an attempt to find gaps in care, you are now directed to specific members who are most likely to benefit from your disease intervention programs. By intervening early, before a member's health worsens, you not only improve the quality of care, but also reduce costs. Actuaries and underwriters can use Predictive Model Tools to evaluate better the risk burden of renewing groups. This knowledge is extremely valuable when setting renewal premiums and can help your organization improve your medical cost ratios. IDS, Inc. utilizes Symmetry Health Data Systems - Episode Risk Groups^TM (ERGs) as the underlying methodology supporting our Predictive Model.