Healthcare Insurance · 5 min read
High-Risk Member Identification: The Three-Month Lag That Costs Health Plans Billions
Claims-based risk identification tells a health plan which members were high-cost last quarter. Predictive risk stratification tells them which members will be high-cost next quarter. That three-month difference is the window for proactive intervention. A preventable hospital admission costs $12,000 to $20,000. The care management contact that prevents it costs a fraction of that — but only if it happens before the admission, not after.
12 May 2026
Care Management
Risk Stratification
