What’s in scope.
The list below describes the standard work breakdown. Every engagement is scoped to client volume, line of business, and platform. Bespoke scope is the default, not the exception.
- 01
HCC Recapture Modeling
Member-level propensity scores that tell your prospective program where to spend the next outreach hour.
- 02
Lapse & Disenrollment Risk
Predict commercial & MA disenrollment 90 days out. Tie into retention workflows by tenured staff.
- 03
Fraud, Waste & Abuse Signals
Unsupervised outlier detection + supervised classifiers trained on your historical SIU case outcomes.
- 04
ED Utilization & Readmission
Member-level 30-day readmit and avoidable-ED risk scores, integrated to care management.
- 05
Provider Performance
Specialty-adjusted cost and quality benchmarks. Goes into VBC contract design and network strategy.
- 06
MLOps & Monitoring
Drift detection, retraining cadences, fairness checks, and explainability reports. Audit trail for every prediction.