Case Study: Humana Medicaid achieves targeted risk stratification and proactive care planning with SS&C Technologies' ACG System

Humana Medicaid - Customer Case Study

Humana Medicaid needed a fast, scalable way to stratify its Medicaid population to identify members with the highest predicted utilization and specific health needs so care teams could act proactively and reduce administrative burden. To do this, Humana Medicaid partnered with SS&C Technologies using the Johns Hopkins ACG® System (distributed by SS&C) to segment members by resource use and risk and support human‑centered care planning.

SS&C Technologies implemented the ACG System and its Patient Needs Groups (PNG) framework to create risk cohorts and care‑focused subgroups, enabling targeted interventions and program design. The analysis produced actionable metrics — Healthy Adults & Children 30%, Emerging Risk 25%, Medium Risk 5%, High Risk 40% — and showed the two highest‑risk groups (15% of members) account for 83% of total claims, guiding high‑touch care, SDoH and behavioral‑health efforts and informing state/regional initiatives.

Humana Medicaid