Cost Containment Services
Predictive Modeling Program
Medical Rehabilitation Consultants utilizes proven predictive modeling software to predict health risk/cost by member and stratify members into risk groups allowing us to identify and focus on the sickest, most costly patients and to manage total claims costs.
This application applies evidence-based clinical rule sets and advanced mathematical processes to claims, membership and other data (lab, health risk assessment, etc.) to identify high-risk members and rank them by need. The resulting data reports then allows us to use these clinically based forecasts to show you the best way to allocate resources efficiently and intervene before adverse outcomes occur and dollars are spent. Our reports generate a list of members with chronic conditions and a profile of Impact Opportunities – areas that provide the greatest potential for intervention and management. Standard reports present clinically relevant data about expected inpatient, pharmacy, and emergency room use, along with total expense projections.