Start with a high-level understanding of what parts of healthcare spend are driving trends within a specific organization or book of business.
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since 2019, according to a recent study.**
*109 claims per million members in 2019 to 158 in 2022.
**SunLife study from May 2023.
Stop-Loss coverage de-risks self-funded employers from catastrophic or unpredictable losses associated with high-cost claimants. Stop-Loss itself is not medical insurance – it’s a financial and risk management tool.
Annual premiums increase when too many claimants exceed their deductible. Be data-driven to reduce long-term costs.
See members and amounts, even before they hit a Stop-Loss deductible threshold. See details around:
Flags members that meet policy trigger criteria (diagnoses, conditions, specialty Rx, etc.) on a running basis. See running totals.
Shows month-by-month actuals and projections. See who is likely to meet or exceed deductibles and when for accurate planning.
Uncovers rising risk. See who is approaching (configurable) thresholds, like 80% deductible AND projected year-end estimates.
Ingests your existing policy and adapts analytic processing to your contract details
Reports reflect your policy, configured thresholds, and risk definitions
Predicts which members will meet deductibles
Process sophistication accounts for Laser lists and varying deductibles.
Increase the accuracy of forecasts, plans, budgets, spend and financial reporting
Design across health plan and stop loss policies to optimize costs
Help members with hyper-personalized care plans and healthcare resources
Stop-Loss policies are highly customized. Many include laser lists – these contain specific individuals expected as high-cost claimants. These individuals have a unique (higher) deductible.
Accurate laser lists ultimately keep Stop-Loss premium lower for the rest of the population.
Smart Stop-Loss packages up information for easy decision-making for next year’s laser lists based on existing health profiles and individual costs.
All analytic views produce results that account for each member’s unique deductible amount.
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We’d love to share a little more about our company and our solutions.
Download for more details on what we do and who we serve. Contact us with any additional questions – we’re here to help!
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Need formal reporting, at scale?
Need interactive dashboards with data visualizations?
Need to present analytics alongside original content or commentary?
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HDMS provides predicitive models, pre-defined segments, model scores, historical predictions and more.
Bring member-level scores and cohorts into a cross-prediction analytic view.
There’s power and sophistication wrapped up in an intuitive user experience – so you can do more than look back on historical trends.
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HDMS clients – have your team walk you through the latest models.
What do you do next? We’ll make sure your data supports your next steps and actions.
Health “Big Data” is a beast. It’s not as simple as other Big Data. What’s important to think about regarding the architecture of a health “Big Data” platform? What’s so special Enlight? Keith Wilton, head of Product at HDMS shares some inside views.
Listen in…
There’s so much data and so many metrics these days. Maybe you don’t have time to check in and investigate results everyday.
Create Alerts in Enlight. Let data tell you when you need to dig in. Use Enlight’s proactive insights to make more time in your day.
Health data is complex, but once unlocked, gives us access to deep insights. Share what you see with others at your organization and break through barriers that slow down your transformation.
Use Enlight’s analytic insights to help define a better path to health for your population.
Health data is complex, but once unlocked, gives us access to deep insights.
See an example of KPI dashboards. Use or configure for customers or plan sponsors.
Do more with data.
Use Enlight’s analytic insights to help define a better path to health for your population.
Take a close look at how social determinants influence costs and utilization for your population.
See the value and impact of point solutions. How do they affect total costs and overall health?
How equitably do plans and networks meet diverse population needs?
Predictive models help you anticipate costs and identify ideal targets for specific actions.