Risk ID and Stratification
Advancing population health management through AI-driven risk stratification and predictive healthcare analytics.
Predictive Analytics
Risk Modeling
AI/Machine Learning
CLIENT
Regence BlueCross BlueShield
INDUSTRY
Healthcare Analytics
DURATION
10 Months
SERVICES
Product Development, Data Strategy, Risk Mitigation
The Risk Identification and Stratification (Risk ID & Strat) initiative uses AI and advanced analytics to identify health plan members at risk of worsening health outcomes or rising healthcare costs. By analyzing claims data, Social Determinants of Health, and other key factors, the model predicts future risk and uncovers the drivers behind it. These insights enable health plans to proactively intervene through targeted care management, improving outcomes while optimizing healthcare resources.
$48K
Potential cost savings
Targeted care management interventions can reduce healthcare spending by up to $48,000 per high-risk member through earlier clinical and social support engagement.
200M+
CLAIMS DATA POINTS ANALYZED
Predictive models are trained on one of the nation’s largest healthcare claims datasets, enabling accurate forecasting of high-cost events and avoidable care utilization.
9
KEY HEALTH BARRIER DOMAINS
Risk models analyze nine major domains—including access, environment, social support, and financial constraints—to uncover the root causes behind deteriorating health outcomes.
13%
SEVERE RISK SEGMENT
Approximately 13% of high-cost members fall into the most severe barrier category, facing multiple Social Determinants of Health challenges that significantly impact care access and outcomes.