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HELP YOUR MEMBERS MAKE BETTER CHOICES


HEALTH PLAN MEMBERS OFTEN MAKE SUB-OPTIMAL CHOICES WHEN DECIDING WHETHER AND HOW
TO ACCESS CARE. NEXTHEALTH HELPS YOU GUIDE THEM TO MAKE BETTER CHOICES WHICH
IMPROVE OUTCOMES, MEASURABLY.

You want members to make the right choices concerning their care. Too often,
they don’t. NextHealth helps you change that by optimizing the effectiveness of
your member interventions across a broad range of use cases and measure the
value of the improved outcomes realized.

Our Solutions



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THE PATHWAY TO BETTER MEMBER CHOICES

Health plans struggle with the most unpredictable and seemingly uncontrollable
factor: human behavior. We help you identify key themes and act on them using
your data and our technology and expertise. With NextHealth, you’ll have the
insights and action plan to continuously identify and influence member behavior,
improve activation and outcomes, and move the needle on costs across a broad
array of use cases.

Here’s how NextHealth helps health plans create and maintain the pathway that
help members make better choices.


INTELLIGENTLY PREDICT LIKELY MEMBER CHOICES.

We use your existing data. Next, we use advanced technology and expertise to
identify which members are most likely to engage in sub-optimal choices. We show
you your highest potential opportunities and baseline performance across an
expansive list of identified use cases.

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BUILD AN INFLUENTIAL MEMBER OUTREACH ACTION PLAN.

Once you know when to focus your attention, now it’s time to engage members and
influence them to make better choices. NextHealth will help you set the right
goals. Leverage our proprietary targeting algorithms to generate advanced member
segmentation schemas and create and execute high-impact member outreach
campaigns.

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MEASURE AND QUANTIFY CAUSAL IMPACT.

NextHealth’s technology and expertise helps you identify the pattern and impact
of better choices. We enable configuration of all your outreach programs,
including populations, Key Performance Indicators (KPIs) and similar
measures. We show you the causality of action and intervention efforts.

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CONTINUOUSLY OPTIMIZE FOR BETTER MEMBER CHOICES.

NextHealth helps you deploy a continuous test and learn approach that delivers a
new level of intelligence based on what’s working and where to focus next. With
NextHealth technology and expertise, you’ll quickly realize optimal engagement
and utilization patterns for members – all of which produce better outcomes and
lower cost of care.

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WHAT USE CASES ARE ON YOUR MIND?

Members make choices everyday. They do so across every operational domain within
your health plan. Understanding the use cases you’re addressing is critical to
shifting member behavior to the right choices–choices which deliver improved
outcomes while reducing costs or increasing revenue. There’s always another use
case, another challenge facing you. The real question is often, where to begin.
Here’s some of examples of use cases across different domains–areas where
NextHealth has solutions to help you.



CARE MANAGEMENT



Care management use cases involve getting more members involved in care
management programs proven to improve outcomes. These programs drive better
activation into care, sustained engagement, and optimized enrollment.

UTILIZATION MANAGEMENT



Utilization management use cases involve influencing members to access care via
appropriate but less costly sites of care. Areas of focus include redirects from
high-cost, less optimal settings to more appropriate alternative physical and
virtual settings.

PROVIDER NETWORK PERFORMANCE



Provider network performance use cases focus on creating collaboration between
payor and provider. It targets members who are likely to realize improved
outcomes which results in better quality ratings. It also helps providers
maximize VBC contract reimbursements with the payer.

RISK ADJUSTMENT



Risk adjustment use cases focus on helping the payor receive appropriate
reimbursements based on the health of their membership. This applies across
lines of business (Medicare, Medicaid, and Exchange) and fosters improvements in
areas which help accurately identify and accurately capture HCC codes.

QUALITY & RATINGS IMPROVEMENT



Quality and ratings improvement use cases focus on improving member health
through better care, such as improving the rate at which members receive
wellness visits, vaccines, diabetic eye exams, cancer screenings, and similar
care. Improved activation into these care settings also improves STARS and HEDIS
ratings for plans.

MEMBER ACQUISITION & RETENTION



Member acquisition and retention use cases today fall under key business areas
such as increasing commercial member conversions to Medicare Advantage plans and
improving member retention for both Exchange and Medicare Advantage.

ASO—COMPETITIVE PARITY & DIFFERENTIATION



Competitive parity and differentiation use cases focus on validating the value
and competitive advantage of various internal and third-party vendor programs
provided by payers. Example use cases include things like justifying the value
of care management programs offered to employers (often called "buy-ups") and
supporting health plan initiatives with ASO clients to engage employees and
improve outcomes.





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CLIENT TESTIMONIALS

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EXECUTIVE VICE PRESIDENT, HEALTHCARE ECONOMICS AND OPERATIONS

BLUE PLAN

NextHealth was huge in helping us feel very comfortable with the propensity
score and the matching of comparing cohorts…which makes us really comfortable
with calculating the ROI. If we are sitting down in front of a large account, we
need to be very confident with the integrity of the case study.


CHIEF DATA OFFICER

REGIONAL BLUE PLAN

The findings indicate that the advocacy model worked well. Coupled with the
ability of NextHealth’s platform to dig deep, our longstanding client saw a
clear path to move forward and expand the advocacy program to their general
population.


SENIOR DIRECTOR: MEDICAL COST STRATEGY & MANAGEMENT

NATIONAL HEALTH PLAN

We truly care about our members with a goal of providing “Human Care”. Our work
with NextHealth is advancing that goal in our commercial population to deliver
personalized care when and how they need it.


CHIEF DATA AND ANALYTICS OFFICER

BLUE PLAN

No one gets a program right the first time. Having a platform to enable
continuous measurement ensures that we keep adding value, bit by bit.


CHIEF DATA OFFICER

REGIONAL BLUE PLAN

Inbound customer service programs are another arrow in our quiver of options to
influence people to make optimal choices and fully utilize their health plans,
and NextHealth’s scalable platform makes rapid and detailed evaluation of member
outcomes and decisions earlier.

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EXPERIENCE MATTERS

Our team has a proven track record of success impacting some of the highest
spend healthcare use cases.

Learn More
70+ million members in plans we partner with
60+ programs and 100s of KPIs
10+ billion data points talking to us
Optimizing utilization and reducing costs

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ABOUT NEXTHEALTH

Here are answers to some questions you might have about NextHealth.



WHO ARE YOUR CUSTOMERS?

Our customers are health plans. We currently support tens of millions of members
make better decisions on behalf of national and regional health plans. 

WHAT TYPES OF SOLUTIONS DO YOU PROVIDE HEALTH PLANS?

We provide technology and services solutions to address use cases across all
health plan domains such as care management, marketing, provider enablement, and
risk adjustment. Any department concerned with impacting member choice will
benefit from our solutions.

ARE YOU MORE THAN A MEMBER ENGAGEMENT COMPANY?

Yes.

Member engagement companies tell you whether a member responded to a phone call
or clicked on an email.

The core of NextHealth solutions is outcomes measurement, so we tell you as a
result of responding to a phone call or email, did the member’s claims behavior
change, if so by how much, and with what statistical confidence can we calculate
the value of the improved outcomes. The difference between the former and the
latter is best described as the difference between checkers and chess.


WHAT ARE YOUR USE CASES?

BRING US YOUR TOUGHEST PROBLEMS. WE’LL EITHER HAVE A WAY TO ADDRESS IT OR POINT
YOU IN THE RIGHT DIRECTION.



WE’RE HERE TO ENSURE YOUR SUCCESS, PERIOD. MEMBER CHOICE IS TOO IMPORTANT TO
LEAVE TO CHANCE.

Get in Touch

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