Case Study: Large Healthcare Community improves vulnerable patient outreach with EXL risk stratification scoring model

Risk stratification scoring model for vulnerable populations

EXL worked with a large healthcare community that was struggling during the early COVID-19 pandemic, when emergency rooms were overwhelmed and scheduled patient visits dropped sharply. The customer needed a way to identify the most vulnerable patients in its Medicare population and prioritize outreach for telehealth consults or in-person visits.

EXL developed a flexible risk stratification scoring model using medical history, existing conditions, lab and medication utilization, and time since the last physician visit. The solution produced low-, medium-, and high-vulnerability lists that helped the customer reach out to patients who needed care, resulting in more than 80-85% of vulnerable patients being scheduled during the peak of COVID uncertainty, mortality rates of 7% for high-vulnerability patients versus 2% and 1% for medium and low groups, and eventual rollout across nearly 200,000 patients.