Case Study: Large Regional Health Plan improves care management outcomes with EXL Health population analytics

Proactive risk management and improved outcomes for a leading health plan through EXL Health population analytics

EXL helped a large regional health plan that could identify members needing care management but struggled to engage them effectively without adding strain to nursing staff. The health plan also needed better visibility into care gaps for targeted members and a way to improve compliance with treatment plans, provider visits, and medication use.

Using EXL Health’s population analytics and care management solution, EXL identified rising-risk members, prioritized those most impactable and intervenable, and improved member outreach with predicted communication channels and SDOH-informed engagement strategies. The result was a 5% to 10% increase in care management enrollment, a 10% higher intervention completion rate for chronic future-risk members, reduced nurse capacity needs, improved HEDIS gap closures, lower total cost of care, and stronger Medicare Star and value-based contracting performance.