While HiCCs represent fewer than one in 1,000 of all Blue Plan members, they are expected to generate nearly
The BCS and BHI HiCC solution, currently being implemented by five Blue Plans, is called the High Cost Predictor Algorithm (HCPA). It uses machine learning to efficiently achieve the needle-in-a-haystack work of identifying who among tens of millions of Plan members will reach or exceed more than
"BCS is committed to helping Blue Plans and their members achieve high-quality healthcare at a lower cost through a variety of tools and reinsurance solutions, and we are thrilled to add this leading-edge solution to our cost-containment offerings," said
BHI specifically trained and validated the HCPA using longitudinal claims information from more than 190 million Americans in its National Data Repository, along with publicly available socioeconomic and claims derived data. BHI's data scientists evaluated thousands of predictive variables to isolate the clinical complexities, utilization patterns, and contextual factors most closely linked to extremely high costs.
"The combination of BHI's machine learning, artificial intelligence, and clinical validation make these predictions extremely scalable, actionable, and accurate," said
The HCPA is now part of the BCS Risk Navigator suite of cost-containment solutions. Using its National Data Repository, BHI augments the predictive model output with additional historical insights on each member to aid nurse reviewers.
Leveraging the power of medical and pharmacy claims data from more than 190 million Americans, Blue Health Intelligence (BHI) delivers insights that empower healthcare organizations to improve patient care, reduce costs, and optimize performance. Our team of data analysts, clinicians, IT experts, and epidemiologists provide analytics, software-as-a-service, and in-depth consulting to healthcare stakeholders. Blue Health Intelligence is an independent licensee of the
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SOURCE Blue Health Intelligence