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Hospital Admission Prediction Engine

Intervene before high-cost episodes occur

Predictive Models

90-day forward-looking risk scores updated daily

Intervention Triggers

Automated alerts to care managers when risk crosses thresholds

ROI Validation

Track prevented admissions vs. control groups

Prevent Admissions Before They Happen

The average inpatient admission costs $15,000-$30,000. Most are preventable with timely intervention— medication adherence support, care coordination, home health, or ambulatory urgent care. But reactive utilization management only sees members AFTER admission when it's too late. Our engine predicts who will be hospitalized in the next 30-90 days so care teams can intervene proactively.

The $4.8M Savings Model

Without Prediction
  • • 240 admissions per year (2,000 employees)
  • • Avg cost: $20,000 per admission
  • • Annual cost: $4.8M in inpatient claims
  • • Care managers react to discharges
  • • 28% readmission rate within 30 days
With Prediction + Intervention
  • • 180 admissions prevented (75% success rate on high-risk)
  • • 60 admissions occur despite intervention
  • • Intervention cost: $800/member (high-risk cohort)
  • • Net savings: $2.4M (prevented admits - intervention cost)
  • • Readmission rate drops to 14%

How Prediction Creates Intervention Windows

30-Day High Risk

Member has 60%+ probability of admission in next 30 days based on recent ER visits, missed medications, chronic condition progression signals. Trigger immediate care manager outreach, medication reconciliation, telehealth check-in, or urgent care redirection protocol.

Intervention ROI: $800 care management cost prevents $20,000 admission 75% of the time = 18.8:1 ROI on high-risk cohort

60-Day Moderate Risk

Member trending toward high risk—recent lab abnormalities, increasing Rx utilization, psychosocial stressors documented. Schedule preventive PCP visit, adjust medications, coordinate specialist follow-up, or enroll in disease management program before condition escalates.

Prevention Window: 60 days allows scheduling PCP appointments, medication titration, home modifications—interventions that need lead time

90-Day Emerging Risk

Member shows early warning signs—new chronic diagnosis, suboptimal adherence, lifestyle risk factors. Enroll in wellness coaching, benefits navigation, or digital health programs. Build relationship with care team before acute episode develops.

Upstream Engagement: 90-day horizon allows relationship-building interventions that require member trust and buy-in