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Health Plan Generates 10:1 ROI for Targeted Care Management Outreach 


Challenge 

A national managed care organization wanted to better utilize its care management resources to mitigate hospital readmission for their Medicare Advantage population by:

  • identifying individuals’ likelihood to be readmitted within 30 days following discharge over the next 6 months

  • improving care management engagement rates

  • improving health outcomes

Solution

The plan partnered with Welltok’s analytics team to analyze their 140,000 members to identify the right individuals for tailored care management outreach.

Welltok leveraged its proprietary consumer database to supplement the client’s data and create a longitudinal view of each member, helping to establish a predictive model.

The key attributes for the predictive model included socioeconomic status, voting history, education level, medication adherence rates, demographics, etc. This allowed Welltok to understand each member’s behaviors and preferences. Applied advanced analytics and modeling identified each member’s:

  • risk of 30-day readmission within 6 months

  • receptivity to care management program outreach

  • likelihood to be impacted by the program to mitigate readmissions

Upon analysis, Welltok provided the health plan with a target list for tailored outreach.

Results 

By combining consumer and client data, Welltok identified individuals at risk of 30-day readmission within 6 months as well as those who would likely be impacted by the care management program and receptive to outreach.

The health plan ultimately improved their ROI, increased care management rates, and increased medical cost savings.

Highlights:

  • 10:1 return on investment

  • 10% improvement in program engagement

  • 16% increase in medical cost savings

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