Case Study: Health Care Service Corporation achieves population-wide predictive care management and cost savings with Truven Health Analytics

Health Care Service Corporation - Customer Case Study

Health Care Service Corporation (HCSC), the parent of Blue Cross Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas, serves about 12 million members and sought a scalable way to improve clinical outcomes by stratifying its entire membership and identifying where interventions would be most effective. The challenge was to build a predictive, actionable segmentation approach that used more than just claims data—incorporating labs, demographics, health risk assessments and lifestyle information—to assign each member to a clear health-status category and prioritize care opportunities.

Working with Truven Health Analytics, HCSC implemented the Advantage Suite (Medical Episode Grouper, Diagnostic Cost Grouper and Market Expert) to generate Health Status Categories and an Opportunity Score for every member, delivering results to care managers and the member portal. The solution reduced manual review, retired a legacy reporting tool (saving over $1 million), lowered administrative costs by more than $250,000 annually, helped win several hundred thousand new lives and exceed revenue targets, and is expected to produce strong long-term clinical and financial returns.

Health Care Service Corporation

Joe Taylor

Vice President and Enterprise Process Leader