Unsupervised for Health Insurance Payers
Strategic Insights for Profitable Growth
Uncover hidden opportunities to grow market share, identify retention risks, and maximize member profitability.
Increase Market Share
Pinpoint key regions to target for surgical marketing campaigns against high-impact member cohorts
Bolster Member Retention
Elevate retention rates with improvements to member benefits and managed care strategies.
Optimize Profit
Maximize profit per member per month by finding new ways to refine supplier contracts, and streamline claim management.
Surface What You Don't Know About Your Data and What to Do About It
Our AI agents continuously traverse complex healthcare data to find new opportunities. Gain your competitive edge with insights for choice rate, PCP network strength, member profits, enrollment, and retention.
Where should I invest to capture market share?
The Medicaid market is changing rapidly due to post COVID-19 public health emergency redetermination unwinding. All MCOs are experiencing increased competition and cost pressures as a result.
Hotspot Locations for Growth: See unique member demographics that are growing most aggressively in specific zipcodes. Refine marketing messaging towards specific plans that benefit those members most.
Quality of Care: Patient access to primary care physicians can impact member enrollment and retention trends. Monitor complex internal and external data relationships to make educated decisions on where and when to invest in new facilities.
Personalize Towards Member Preference: Preferences are hidden across member engagements, health diagnoses, plan benefits, and external data. Personalize your care plans and outreach efforts based on hidden patterns buried across these complex data relationships.
What should I focus on to improve profit per member per month?
Payers struggle with high claims costs, inefficient processing, poorly negotiated supplier contracts, and inadequate management of appeals, all of which inflate costs and reduce profitability. Addressing these issues is crucial for improving financial performance and sustaining growth.
Understand the Full Picture: Unsupervised AI helps identify specific demographics, diagnoses, claim types, and supplier contracts that are particularly lossy, making it easy to spot the highest leverage areas for margin improvements. It also flags bottlenecks in appeals and grievances processes, enabling teams to investigate and optimize these areas.
Business Case for Change: By quickly identifying unprofitable situations, MCOs can leverage data-driven insights to explore re-negotiations with state programs. Each re-negotiation is supported with clear data themes showing where suppliers or service providers are more costly than expected.
How can I ensure continuity of care through the plan transition process?
Plan transitions are critical events when data visibility, administrative costs, churn, and member education are all impacted negatively. These transitions also cause shifts in regulatory compliance requirements. Addressing these issues quickly is essential for a smooth transition and to maintain payer profitability.
Longitudinal View of All Plans: Unsupervised assists in increasing visibility as members transition from plan to plan as various life events occur. Knowledge of who is switching, why they're switching, and where educational efforts need to be improved can be used to increase member lifetime value.
Financial & Provider Management: Stay on top of shifts in cost structure and changes in provider networks to ensure consistent access to care.
Healthcare Payers are beating expectations and exceeding their KPIs within months of implementing Unsupervised.
ROI
4X
within 6 Months
Impact
8%
Increase in Market Share
Largest single opportunity
$17M
Monthly
CASE STUDY
Unsupervised Helps Fortune 500 Healthcare Payer Find $58M in Retention and Growth Opportunities
This case study explores how a Fortune 500 healthcare payer used Unsupervised AI to uncover $58M in potential improvements to member growth and retention programs within just six months.
