Care and Condition Management:

Empowering Improved Outcomes, Efficiency, and Cost

Prealize Health’s Care and Condition Management solution empowers improved outcomes, efficiency, and cost savings by providing precise insights into patient health events. We provide Care Managers with a clear roadmap of which patients are likely to experience a health event, helping them to understand the drivers and timing, assess clinical impactability, and estimate associated costs. We provide a 360 degree member view that enables personalized interventions and helps predict each member’s likelihood to engage—determining when, how, and why engagement will be most effective, as well as incorporating social risks.

The Power of Prediction

Predicting imminent health events with hyper-reliable precision is paramount for health plans, specialty care management companies, employers, and providers. We are driving the revolution of moving from reactive, which leads to better care, better outcomes, lower costs, and affordability.

For events within the next 12 months, defined in three month increments, our time-to-event predictions achieve an impressive greater than 85% accuracy benchmark. With Prealize, you’re armed with pinpoint precision, not broad-stroke forecasting, empowering early intervention, significantly reducing costs, and enabling care strategies to be optimized with a level of accuracy that was once unimaginable.

Key Features:
Unveiling a New Era of Proactive Care

Early Identification:
Identify and predict risk, with a 12-month window to proactively engage members likely to become new high-cost and members who will jump in cost by client customizable thresholds
Clinical and Social Insights:
Gain a complete view of each member’s risk by seeing condition and utilization predictions alongside social determinants of health and engagement predictions
Actionable Recommendations:
Our model provides more than predictions—it offers personalized intervention recommendations so care management teams have the insights needed to make impactful decisions

Use Cases:
Accuracy Across the Care Continuum

Chronic Condition Management:
Predict disease progression and complications with unparalleled accuracy, enabling proactive interventions that improve outcomes and quality of life
Behavioral Health Interventions:
Identify members at risk for mental health challenges months in advance, allowing for early support and prevention
Preventive Care Initiatives:
Target screenings and vaccinations to those most likely to benefit, maximizing the impact of preventive care efforts
Care Coordination:
Optimize care plans based on accurate multi-condition risk profiles, ensuring comprehensive and coordinated care for complex patients

Client Case Study: Regional Southeast Health Plan

Proven Results:
Where Accuracy Meets Impact

Improve patient outcomes
Execute on effective and personalized care plans
Provide 360° Member view
Empower Next Best Action (NBA)
Create impactful engagement—reaching the right member, at the right time, through personalized and timely outreach

Demonstrated Client Value:
Accuracy That Transforms Care

Regional health plan using Prealize’s Care and Condition Management solution:

$30M
Avoided medical spend totaling $30M over 3 years
$564
Yielded $564 average savings per engaged member per month in cost avoidance across all lines of business
20%
Prealize proactive cases had 20% higher engagement than similar cases already in care management
Prealize provided insights that allows our care managers better intelligence to intervene and impact members at the point of care.
VP, Care Management for regional health plan

Empower Your Care Management Team

Let’s discuss how Prealize can bring a new level of precision to your financial risk management strategies.

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