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How understanding member risk and behavior can help health plans personalize programs, products and services

With health care reform, health plans will face growing competition, increasing medical expenses, a weak individual mandate and limited underwriting. As more uninsured consumers enter the market, while the insured switch to different plans, insurers will know little about their company's risk profile. Health plans need to attract and retain a balanced membership portfolio of high- and low-risk members and understand the real risk associated with different prospects and members so they can align products, programs and services to manage costs. This paper explains how, in preparation for the changing health care market place, some plans are utilizing analytics by integrating data, building segmentation models and aligning internal resources under an Analytic Center of Excellence (COE). With the tidal wave of changes in the market, advanced analytics will quickly become a lifeline for all health plans.

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