5% of patients account for 50% of healthcare spending. Most health systems can't identify these patients until after expensive events. Social determinants of health (food insecurity, housing, transportation) drive 40% of outcomes but aren't in clinical data. Claims data analysis requires expensive data warehouses and analysts. Risk stratification models in EHRs are basic.
Population health platform that combines clinical, claims, and social determinant data to risk-stratify populations, predict high-cost patients, recommend interventions, and track outcomes — enabling proactive care management that reduces total cost of care.
ACOs (Accountable Care Organizations) managing shared savings risk, health systems with value-based care contracts, and Medicaid managed care organizations with high-risk populations
Value-based care is accelerating — 60% of payments will be value-based by 2027. CMS requires quality reporting for reimbursement. SDOH data sources are newly accessible. AI prediction models are clinically validated. Health equity is a regulatory priority.
Per-member: $2–$5/member/month (PMPM) based on population size. Platform: $2,999/mo (up to 10K lives), $4,999/mo (50K lives), $9,999/mo (200K+ lives). Savings share: optional 10–20% of demonstrated savings.
Basic reports, no claims integration, no SDOH, limited risk stratification
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