Case Study: Large Southern California Physician Group improves palliative care targeting with Clarify Health

Providing predictive analytics with true prospective outlook on individual members enable plans and providers to better address individual needs and avoid high cost events

A large Southern California physician group with more than 500,000 covered lives across Commercial, Medicare, and Medicaid needed a better way to identify high-risk patients for care management and palliative care. The group wanted to move beyond existing clinical protocols and more accurately predict which members would become future high utilizers, so it turned to Clarify Health and its Clarify Risk Member Risk solution.

Clarify Health implemented prospective predictive models using claims, clinical, geographic, and social/behavioral data to flag patients earlier and match them to the right interventions. The results included more accurate 12-month mortality predictions, 34% better model accuracy versus Elixhauser, 2-3x improvement in care manager productivity, and more than $5K in savings PMPY for the high-risk pool; Clarify also identified palliative care candidates 66% earlier on average, helping reduce inpatient days and improve patient and family satisfaction.