Know what works.

Optimize around proven data.

Stop Guessing What Works.

Know what drives ROI.

Today’s market pressures make it more critical than ever for health plans to deliver medical cost reductions and better outcomes for their members. But just identifying populations for new programs is a long way from delivering sustained and proven results, at scale. How do you drive effective behavior change and measure the impacts in real-time?

The NextHealth solution enables you to identify the most impactable members, reach them effectively, and measure and optimize performance for the highest ROI, at scale and in real-time. The system easily scales to dozens of different use cases from reducing ER overuse to addressing potential opioid abuse.

Move from high risk to high impact.

Know what works and what’s wasted.

Invest only in programs that work.

Proven delivery of $6-$42 PMPM savings.

Key NextHealth Platform Benefits

That drive outcomes.

Supercharge Data
The NextHealth platform merges and transforms data from many sources – claims, programs, providers, demographics, etc. – to create a Master Member Dataset (MMD) that can drive insight generation, prediction, and optimization algorithms across multiple KPI’s.  The resulting data structure is completely extensible and flexible to accommodate new data sources and new use cases.  We can even include outputs of your own prediction and risk scoring algorithms to create more powerful, hybrid predictions.  The platform utilizes automated, proprietary algorithms that restructure data types, impute missing values, and eliminate redundant predictors to maximize predictive strength and information content.

Automate Insights
NextInsight™ automates predictive analytics in order to reduce many of the labor intensive, trial-and-error tasks formerly required to segment customers and analyze KPI’s.  Attribute correlation, importance, and clustering are automatically generated and displayed to reveal key drivers and member characteristics of customer subpopulations.  Analytics teams can use this information to inform targeted campaign designs or other strategic outreach initiatives.

Measure Outcomes
NextLift™ statistically estimates both the lift and its significance for each intervention or “nudge”. By using randomized controlled trials – often seen in other industries but unique in healthcare analytics – it is possible to isolate the change due to the nudge itself versus some other systematic factor that may be operating upon your target populations. By considering significance, you can know with a high degree of confidence that the measured lift is caused by your intervention, and is not just simply a reflection of random variations in the data.

Optimize Impact
NextLift™ uses the current outcome measurements to adjust the next round of assigning members to campaigns.  Our unique simulation-optimization approach is able to determine the optimal size of each campaign to maximize expected future lift without exceeding campaign resource constraints.  Prediction algorithms feed the members at highest risk into these campaigns while also considering the campaign to which the individual member will best respond.



Yes, this is a great way to start and get organizational adoption. Once the data is uploaded, we can use simulated RCTs, difference in differences, A/B tests and other statistical methods to determine within 30 days whether or not your current programs are generating results.

Member engagement begins within 90 days of data receipt. Outcomes are measured with every data refresh, starting 30 days from deployment. Want to learn more? Contact us.

NextHealth has delivered groundbreaking outcomes such as savings of $144 PMPY in medical costs and 26% reductions in avoidable ER usage in targeted commercial, Medicaid, and ASO populations. We’d love to customize a cost savings calculation for you. Contact us to start the discussion.

Analytics & Data

Our system allows business users to use our standard KPIs or create their own, perform ID strat and do program measurement and optimization on their own. We have helped health plans solve for network leakage, EPSDT, colorectal cancer screening, and avoidable ER reduction. New use cases are continuously being added.

Machine learning refers to algorithms that find patterns in data. These algorithms are typically “trained” on large amounts of input data and then apply that knowledge to new, but similar data for inference and prediction. NextLift™ and NextInsight™ use several algorithms from machine learning to predict KPI’s for members from large amounts of historical member attributes. NextLift™ also incorporates an adaptive learning cycle where results from previous deployment iterations feed back into the platform, and new deployments are re-optimized according to the latest results. However, this cycle is not considered “machine learning” in the traditional sense.

We randomly assign members to trial and control groups during the nudge assignment algorithm via computer generated random numbers. There is no human intervention, and randomization occurs independently of any attributes other than membership within a population. The randomization is generally set to generate an average of 1 control member for every 2 trial members.

We don’t incorporate models directly, but we can incorporate the output of your models. Those outputs will be used as a set of risk groupers which are fed into our NoSQL database to be combined with the variables that our platform identifies to see which variables are the most predictive of impactable risk. We can also augment data with 3rd party sources to add contact data or other variables including social determinants of health that can strengthen our predictive ability.

Working with NextHealth

After an initial conversation, we work with you to identify high-level metrics to build a business case which is important in benchmarking the outcome and in the engagement. This process typically takes 30 to 60 days.


Existing programs can be run through our systems in 60 days or less for a post mortem assessment.

To get up and running with a new program, it takes roughly 90 days to load data into the platform, create clinical program campaign content, and prepare for launch. On day 91, we start engaging members.

Engagement can be done by NextHealth or inhouse depending on the deployment approach. We can also load and measure existing clinical programs which gives you additional value while results begin to come in from newly launched programs and those results can be seen as soon as the data is loaded and run through the system.

We continue measurement and optimization on a monthly basis for the term of the contract.

We work closely with your analytics group and offer several services to scale and ramp your team.

We collaborate to conduct audits of your current programs to identify new opportunities to deliver ROI. Many customers initially use our platform with managed services to support rapid launch. And, we train your team how to use the platform for deployment at your pace and scale across your programs.

General FAQs

The NextHealth approach cycles through three questions (Identify, Execute, Optimize). We kick off the process by working with you to identify key opportunities (use cases) to tackle such as avoidable ER visit utilization, wellness visits, out-of-network claims, etc.

  1. Target: Who can benefit the most from your programs? The NextHealth solution assigns predicted risk scoring for each member for the given use case.
  2. Execute: What do you do and say once those members are identified? Firstwe load an inventory of programs (e.g. Nurse Advice Line, Urgent Care, telemedicine, etc.). Then we identify the best channel for outreach (e.g. phone, text, email, direct mail, etc.). The combination of program and channel is called a “nudge”.
  3. Optimize: How well is each campaign working? We use randomized control trials to determine what’s working and for which members. Then, we find the signal in the noise and amplify the programs that have an impact.

NextHealth supports millions of members on its platform on behalf of national and regional health plans. We’d love to talk with you about how we can reduce medical costs for your plan. Please contact us for more information.

You can start with an audit of current programs, deploy using the NextHealth SaaS platform using professional services, or ramp your analytics experts on the NextHealth Platform. To learn more, contact us.



Predictive analytics uncover the populations that can most impact the targeted use case based on a rich data set. The platform pinpoints avoidable and impactable behavior vs. just finding the highest risk patients. This approach means you can focus resources on fewer total members while concurrently driving better (and bigger) outcomes.


Prescriptive analytics define the best outreach strategy based on the unique attributes of each population and the available programs - the “next best action”. The consumer engagement element in the platform manages the messaging and execution of interventions across all channels, including call center, direct mail, email, SMS texts, and websites.


On the platform dashboard, dive into the details of each campaign to gauge what worked for which members, how well your delivery channels performed, and where your ROI was greatest. Machine learning optimizes subsequent campaigns to deliver only those interventions that worked well to the populations most likely to respond to them, saving you time and money - and maximizing outcomes.