Case Study: Large Top 5 Insurer Provider achieves robust cost-trend prediction and high-risk patient identification (43% R2) with SCIO Health Analytics

Large Top 5 Insurer Provider - Customer Case Study

Large Top 5 Insurer Provider, covering over 10 million members, needed a new predictive approach to identify which clinically abstracted variables drive future healthcare costs and whether those variables would improve traditional actuarial models. Facing a short timeline and a lack of blended clinical–actuarial resources, they engaged SCIO Health Analytics to develop a prospective predictive risk model using clinically abstracted data.

SCIO Health Analytics deployed specialized staff and built a risk model that leveraged clinical data and gaps-in-care identification, using statistical, quantile regression, and neural net techniques and validated with a 50–50 split sample. The solution produced a robust prospective model (43% R2), removed the client’s resourcing bottleneck, and allowed the Large Top 5 Insurer Provider to confidently identify high‑risk patients for targeted intervention.