Healthcare cost reduction use cases: Reduce ER overuse, readmission reduction and out of network reduction.

Do you know what works to improve affordability?

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Impact Outcomes.

Optimize all your cost, service and value initiatives.

Everybody knows that healthcare costs continue to rise. Changing consumer behavior is incredibly complex, despite the myriad of initiatives meant to steer people to better choices. But knowing quickly what works for whom, why, and what to do about it to reduce costs and improve outcomes has proven elusive.

NextHealth’s advanced analytics platform, powered by AI and machine learning, optimizes workflow to impact affordability and systematically pinpoints what works for whom to drive measurable behavior change.

Focus on amplifying the use cases that can have the biggest impact on affordability. Keep your finger on the pulse of the initiatives in your portfolio that are making the biggest difference and why. 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.

6.3% Reductions ($6 PMPM) in ER Utilization

Challenge:A Colorado Medicaid plan wanted to reduce medical costs by lowering avoidable ER visits. Solution:The NextHealth platform rapidly identified the most impactable populations as well as the specific interventions that were most likely to change their behavior. Outcome:6.3% reductions in avoidable ER visits ($6 PMPM) with statistical significance in the targeted population.

Move the needle on $38B in annual avoidable ER costs

6.3% Reductions ($6 PMPM) in ER Utilization

Challenge:A Colorado Medicaid plan wanted to reduce medical costs by lowering avoidable ER visits. Solution:The NextHealth platform rapidly identified the most impactable populations as well as the specific interventions that were most likely to change their behavior. Outcome:6.3% reductions in avoidable ER visits ($6 PMPM) with statistical significance in the targeted population.

63% Savings ($42 PMPM) in Musculoskeletal Costs

Challenge:A large regional Blue Cross Blue Shield health plan was struggling to better manage both congestive heart failure (“CHF”) costs and associated outcomes for their Medicare Advantage population. Solution:The NextHealth platform not only identified $143 PMPM in savings in an existing CHF management program, but with the expanded number of key performance indicators that the team was able to evaluate using the platform, they identified additional opportunities for musculoskeletal procedure cost reduction in the same population. Outcome:Expansion of the successful CHF management program and a 63% Savings ($42 PMPM) in Musculoskeletal Costs in the targeted MA population.

63% Savings ($42 PMPM) in Musculoskeletal Costs

Challenge:A large regional Blue Cross Blue Shield health plan was struggling to better manage both congestive heart failure (“CHF”) costs and associated outcomes for their Medicare Advantage population. Solution:The NextHealth platform not only identified $143 PMPM in savings in an existing CHF management program, but with the expanded number of key performance indicators that the team was able to evaluate using the platform, they identified additional opportunities for musculoskeletal procedure cost reduction in the same population. Outcome:Expansion of the successful CHF management program and a 63% Savings ($42 PMPM) in Musculoskeletal Costs in the targeted MA population.

Uncover hidden cost reduction opportunities

Pinpoint 60% of ER overuse costs by targeting only 20% of members

Challenge:A regional health plan with $25M in quarterly ER costs launches dozens of initiatives to reduce ER utilization across its commercial membership, from rural populations to expectant mothers and urban families. However, after almost a year of effort, they still don’t know which effort is working and for whom. Solution:Using the predictive targeting features in the NextHealth platform, the team identified the top 20% of members, ordered in terms of risk and impactability, who accounted for 60% of the total ER costs for the entire population. Outcome:Higher ROI on each dollar spent on outreach by focusing resources on the most impactful outcomes.

Optimize resources to focus on what drives ROI

Pinpoint 60% of ER overuse costs by targeting only 20% of members

Challenge:A regional health plan with $25M in quarterly ER costs launches dozens of initiatives to reduce ER utilization across its commercial membership, from rural populations to expectant mothers and urban families. However, after almost a year of effort, they still don’t know which effort is working and for whom. Solution:Using the predictive targeting features in the NextHealth platform, the team identified the top 20% of members, ordered in terms of risk and impactability, who accounted for 60% of the total ER costs for the entire population. Outcome:Higher ROI on each dollar spent on outreach by focusing resources on the most impactful outcomes.