About Optima Health
Optima Health provides health plan coverage to over 850,000 members through a full suite of commercial products. Optima Health has a quality provider network featuring more than 35,000 providers including specialists, primary care physicians and hospitals. Optima Health offers a variety of programs to help their members improve their health.
Optima Health sought the best in class analytics company to support their internal teams. After a careful evaluation, Optima Health chose Prealize based on improved accuracy, which creates the trust Optima Health needs to act on the predictions.
According to VP of Informatics and Analytics, John Coughlin, “Prealize’s predictions were far superior and we wanted something that was cutting edge. Engaging with Prealize accelerated our ability to further improve health and lower costs for the long term.”
Optima Health selected Prealize to identify the highest risk, most impactable members so that their care managers could productively manage their care needs and associated expense. In the process, Optima Health found value in powering other proactive healthcare use cases.
Optima Health achieved a 4:1 ROI in cost savings for members engaged through Prealize solutions in the first 12-months of observation.
“Prealize allows us to make our outreach more targeted. We have a very large population that we are trying to reach with limited resources, and these predictions allow us to gear our outreach efforts to the populations that we can have the most impact on," said Kia Dunbar-Harris, VP of Clinical Care Services at Optima Heath.
Prealize in Action for Optima Health
Optima Health uses Prealize’s predictive analytics solutions to support core business and clinical objectives:
1. Proactive Care Management & Resource Optimization
The Optima Health Clinical Care Services team searched for innovative ways to prioritize the care management team’s time, create efficiencies where possible, and increase value over time by improving member health and reducing cost. Optima Health selected Prealize’s prioritized member list and Action Plans to conduct telephonic care management outreach to the highest risk, most impactable members. Prealize’s prioritized Action Plans allow their care managers to create efficiencies while working a case by reducing time spent combing through EMR data. Dunbar-Harris said, “It’s great to have the case summaries in Prealize’s Action Plans to understand that member quickly.”
2. Supporting ASO Sales
With Prealize’s solutions, Optima Health added a differentiator to stand out in a crowded market and add value to their customers. The Optima Health team is excited to be able to ground their value in member stories whose lives have been improved as a result of proactive outreach against Prealize’s predictions. Optima Health also plans to use the predictive analytics to make program investment recommendations to customers.
3. Supporting NCQA Requirements
Optima Health identified a new opportunity to use Prealize’s predictions to segment their population to satisfy three NCQA Population Health Management categories: PHM Strategy, Population Identification, and Complex Case Management.
“Working with Prealize is great. It’s been a really good partnership. Prealize is always willing to listen, adapt and try new things," said Coughlin.
Prealize is excited about this milestone with Optima Health, and will continue to innovate and provide best in class predictive analytics products to achieve value for all customers.
Interested in learning more about how your organization can achieve cost savings and grow revenue through Prealize's solutions? Contact: BeProactive@prealizehealth.com