Implementation Products

List Generation and Targeting Products

  • Retention. Our tools provide on a monthly or quarterly basis as needed, prioritized lists for Retention, Win-Back of lost members or Groups, cross-business unit opportunities (to Medicare, Medicaid or Individual), pre-ACA to ACA.
  • Acquisition. The identification of target consumer and employer profiles, and the delivery of target addressable and reachable lists for outreach based on these profiles. The Sales cycle “waterfall” is also analyzed to understand weak points and define interventions to improve the close rate at each bottleneck
  • Support for Marketing, as they create CRM and ARM (Agent) tools integrating micro-segment profitability with internal and external sales, demographic & P&L data to help in building B2C and B2B2C capabilities.
  • Channel/Agent alignment lists are provided, based on cross licensing, lapse and duration, products sold, strategic goals achieved or adopted, patterns of engagement for new business and retention. These facilitate sales interventions to educate and improve alignment and manage “ACE” (Adoption of strategic initiatives, Contact methods and frequency, and Entanglement created with barriers to exit.
  • Provider Care/Coding. Lists are provided on a monthly/quarterly cycle to understand provider performance in Care Management programs, adherence to best practices in disease management, proper coding for Risk Adjustment capture, and overall patient outcomes.

Pricing and Predictive Modeling

  • Pricing/Actuarial. In depth pricing analysis to identify opportunities to use all allowed pricing variables to get to the optimum price for each micro-segment. Our approach is to use a “cost plus” floor, and market need based cross subsidization, above the floor, to optimize and grow profitable membership. Tools to support Actuarial can:
    • Identify key non-pricing variables that impact price, product, risk, underwriting
    • Identify Surrogates to supplement or enhance pricing variables
    • Granular configure assumptions used, i.e. Population Weights,       Trend (20+ components), Credibility, Target Loss Ratio, On Level,  ACA changes, etc.
    • Past Pricing Changes (On-level)
    • Pooling of Large Claims (Global or Granular in Demographic or    Clinical Segments)
    • Ability to adjust Population to reflect target market or prospective population
  • Predictive Modeling. We use traditional statistical and emerging AI methods to analyze both structured and unstructured data to predict Lapse/Retention, High Claims, In-Patient Propensity, Propensity to Purchase, Propensity to buy for Protection vs Use, Channel Propensity, Agent Alignment, Price Sensitivity, Risk Adjustment Propensity, Propensity to miss Codes, Provider AMA Compliance. Our meta-data adds significant predictive power.