Case Study: a large regional healthcare organization improves proactive care management with EXL Health

Large Regional Healthcare Organization - Customer Case Study

EXL worked with a large regional healthcare organization serving more than 4.5 million member lives across 40+ U.S. states. The health plan wanted to improve care management outcomes, but its existing approach mainly identified members in immediate need and lacked a proactive way to find early chronic members and those likely to become high risk in the next 2 to 3 years.

EXL implemented predictive and prescriptive analytics using longitudinal health plan data, social determinants of health, utilization trends, and care-gap measures to segment members into emerging risk, impactable, and intervenable groups. The solution helped the client prioritize a 6,200-member final cohort for targeted outreach and care-gap closure, with the case study indicating a much greater savings opportunity for this group than for the broader population, while EXL also set up monthly monitoring of risk, PMPM, utilization, and compliance to measure impact and refine the model over time.