Predictive Modeling enables proactive identification of members as potential program participants. Once identified, participants are then stratified for appropriate programs, services or offerings across the entire spectrum of THM based on their particular health situation.

Member Identification and Index Scoring:

Our third generation predictive modeling technology, based on artificial intelligence, considers all members within our database and assigns an index score to each and every one. This process helps prioritize members for nurse intervention and management - targeting outreach where and when it is needed most.

Based on demographic information as well as previous medical and pharmacy claims data, predictive modeling software projects cost and risk for an upcoming 12-month period. This technology automatically and systematically assesses chronic and acute conditions, identifies gaps in chronic or preventive care, and identifies likely "movers," or those members who seem to be poised to slip more toward illness or high risk. Predictive modeling, combined with our proprietary index scoring system, provides efficient identification of members who are most likely to be impacted by specific timely interventions.

Members are also identified through a variety of other sources - such as authorizations for certain medical services, referrals from physicians, our 24/7 Nurseline, and more. On a case-by-case basis, the most up to date index score can be obtained in each of these cases, too.

Member Stratification:

Enabled by technology and enhanced by nurses, potential participants are placed in the most appropriate level of THM program - m Lifestyle and Wellness through End of Life Management - based on the nature of their condition and the type of support and assistance required at that given time.

And, even though members are initially identified for a certain program or level of THM based on their current condition, they may move across the entire program spectrum over time as their health situation changes.