The Problem: $38+ Billion in Overuse

 38 plus billion in overuse
With an estimated $38 Billion in overuse of non-emergent ED visits, the need for proactive health management to improve quality and care coordination, promote wellness and prevention and reduce avoidable utilization is essential. The DxCG Intelligence - Medical Management Suite identifies patients likely to end up in the emergency department to prioritize proactive interventions and engagement strategies to support those patients and manage medical costs. Source NEHI

The Solution: DxCG Intelligence

Features

  • Forecast population and member-level costs with validated, best-in-class risk adjustment models 
  • Use event-based modeling to predict the likelihood of high cost utilization
  • Measure performance and variation in efficient use of resources adjusting for underlying differences in populations
  • Utilize custom models to assess the unique needs of Commercial, Medicaid and Medicare populations

Benefits

Medical Management Solutions

  • Assess the disease burden of individuals, subgroups or populations
  • Inform care management and evaluate the impact of clinical intervention and quality programs
  • Identify individuals likely to be hospitalized, end up in the emergency room, or incur high cost in the near future

Budgeting and Underwriting Solutions

  • Predict future costs of care for a population and allocate resources appropriately
  • Set underwriting rates and inform stop loss and reinsurance rates
  • Develop fair and accurate risk-based provider payment systems

Performance Assessment Solutions

  • Measure efficiency in health care resource usage compared with expected utilization based on population risk
  • Assess performance relative to peer group or a national benchmark
  • Evaluate the impact of clinical risk and demographics on performance outcomes

Next Steps

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