The $300 million lesson: Predict disenrollment before you knock on the door
By Preet Mehta
Every year, health plans send nurses to the homes of members who will not be members much longer. A Healthy Home Visit generates a paid claim, which feeds the risk-adjustment machinery, which eventually moves state payments — but only if the member is still eligible when the state takes its snapshot. Worse, the visit’s value decays: every subsequent claim eats away at what the visit can still explain. A visit to someone who disenrolled the next month is money spent for nothing. Across our Medicaid population, that waste ran to roughly $300 million. So we built a model to answer one question before scheduling a single visit: will this member still be here in three months?
Medicaid churn is an eligibility problem wearing a clinical disguise
Medicaid makes this harder than it looks. Unlike Medicare’s single national model, Medicaid is a patchwork of state programmes with their...
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