One platform tackles all the use cases that matter to you

Scale in days, not months. 

Use Cases

Avoidable ER use? Network leakage? Member retention? Tackle all of them - and more.

NextHealth’s platform saves tremendous time and money by quickly scaling to multiple use cases. Reduce costs in ER overuse then pivot to reducing out-of-network visits without having to rework your models or data sets. 

Focus on the use cases that matter most to your business. Choose the most predictive KPI’s for each use case from the dozens that are pre-configured, or customize your own. Where are your most avoidable and impactable medical costs?  See below for a few examples of the use cases where customers are already using the platform to radically reduce costs and measurably improve outcomes.

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ER Overuse is a $38B cost*

The Problem:Using the hospital emergency room when there is a more optimal care setting contributes over $38 billion dollar annually to the cost of health care in the United States. Educating members about alternatives (such as urgent care clinics) or helping people get connected with a primary care physician can save plans millions of dollars. The Questions to Ask:How do you know for sure which of your members will be receptive, which alternatives to offer to whom, and the best way to reach them? And if you have limited resources, how do you focus them on the most effective campaigns? The Solution:See how NextHealth offers one orchestrated platform Read the Case Study
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Avoidable ER Use

The Problem: Using the hospital emergency room when there is a more optimal care setting contributes over $38 billion dollars annually to the cost of health care in the United States. Educating members about alternatives (such as telemedicine or urgent care clinics) or helping people get connected with a primary care physician can save plans millions of dollars. The Questions to Ask:How do you know for sure which of your members will be receptive, which alternatives to offer to whom, and the best way to reach them? And if you have limited resources, how do you focus them on the most effective campaigns? The Solution:See how NextHealth offers one orchestrated platform Read the Case Study
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Lost member retention costs $28B per year*

The Problem:The Affordable Care Act and other forces are driving individual health plan membership increases and decreases in employer sponsored insurance. New guidelines mean the profitability of individual members varies widely. Identifying and retaining high value individual members is critical for long-term sustainability. Many health plans are focused on new customer acquisition; but recent studies suggest that customer retention plays a bigger role in profitability. The Questions to Ask:Who are your highest value members and are they satisfied? What programs can you offer to your highest value populations, and how do you measure your success? The Solution:See how NextHealth offers one orchestrated platform
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Member Retention

The Problem:The Affordable Care Act and other forces are driving individual health plan membership increases and decreases in employer sponsored insurance. New guidelines mean the profitability of individual members varies widely. Identifying and retaining high value individual members is critical for long-term sustainability. Many health plans are focused on new customer acquisition; but recent studies suggest that customer retention plays a bigger role in profitability.  The Questions to Ask:Who are your highest value members and are they satisfied? What programs can you offer to your highest value populations, and how do you measure your success? The Solution:See how NextHealth offers one orchestrated platform
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Costs for out-of-network services are 300% higher*

The Problem:According to a Consumer Reports survey, 44 percent of people who bought an Affordable Care Act (ACA) plan for the first time in 2015 reported that they did not know the network configuration associated with their plan. Out-of-network costs can be substantial, both for the plans and for the member. According to a study by the AHIP Center for Policy and Research, prices for out-of-network medical services in 2013-14 were on average 300 percent higher than the average Medicare rates for 97 common medical procedures.  The Questions to Ask:How do you identify which members are at risk of going out-of-network? How do you personalize and frame your messages to ensure they are heard and understood by these populations? How do you prove which of these campaigns work and optimize efforts based on that data?  The Solution:See how NextHealth offers one orchestrated platform
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Network Leakage

The Problem:According to a Consumer Reports survey, 44 percent of people who bought an Affordable Care Act (ACA) plan for the first time in 2015 reported that they did not know the network configuration associated with their plan. Out-of-network costs can be substantial, both for the plans and for the member. According to a study by the AHIP Center for Policy and Research, prices for out-of-network medical services in 2013-14 were on average 300 percent higher than the average Medicare rates for 97 common medical procedures.  The Questions to Ask:How do you identify which members are at risk of going out-of-network? How do you personalize and frame your messages to ensure they are heard and understood by these populations? How do you prove which of these campaigns work and optimize efforts based on that data?  The Solution:See how NextHealth offers one orchestrated platform
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Colorectal cancer expenses cost $14B/ year*

Closing Gaps in Care

The Problem:Not anticipating or closing gaps in care significantly affects the quality and cost of care by contributing to adverse member outcomes and inappropriate care. Take colorectal cancer screening for example. Because symptoms of colorectal cancer often do not manifest until after the disease has progressed, early screening is critical. However, according to the American Cancer Society, colorectal screening rates lag behind other cancer screen rates, despite the fact that colorectal cancer is the third leading cause of cancer-related deaths in the United States. The annual medical expenditure for colorectal cancer was estimated at $14 billion dollars in 2010. The Questions to Ask:How do you focus on those members who would most benefit from closing gaps in care? Which clinical programs would each population most benefit from and how do you personalize and frame your messages? How do you measure what worked and for whom?  The Solution:See how NextHealth offers one orchestrated platform
LET'S HAVE A CONVERSATION

Closing Gaps in Care

The Problem:Not anticipating or closing gaps in care significantly affects the quality and cost of care by contributing to adverse member outcomes and inappropriate care. Take colorectal cancer screening for example. Because symptoms of colorectal cancer often do not manifest until after the disease has progressed, early screening is critical. However, according to the American Cancer Society, colorectal screening rates lag behind other cancer screen rates, despite the fact that colorectal cancer is the third leading cause of cancer-related deaths in the United States. The annual medical expenditure for colorectal cancer was estimated at $14 billion dollars in 2010.  The Questions to Ask:How do you focus on those members who would most benefit from closing gaps in care? Which clinical programs would each population most benefit from and how do you personalize and frame your messages? How do you measure what worked and for whom?  The Solution:See how NextHealth offers one orchestrated platform
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Source data

Closing Gaps in Care
Mariotto, A.B., K.R. Yabroff, Y. Shao, E.J. Feuer, M.L. Brown. 2011. “Projections of the Cost of Cancer Care in the US.” 2010-2020.” J Natl Cancer Inst 103(2): 117–28.

See more at: http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2015-table-of-contents/colorectal-cancer#sthash.bFQDW35v.dpuf

Network Leakage
Charges Billed by Out-of-Network Providers: Implications for Affordability. 2015. AHIP Center for Policy and Research.

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