Skip to main content

For health plans, targeting only the high-risk members or those expected to develop a chronic illness means lost opportunities. That’s why health plans are increasingly using impactability scores to direct care management interventions and deliver a higher return on investment. Impactability also offers health plans a powerful tool to influence a consistent pain point, member choice.

The chart below is a basic example comparing a high-risk member with an impactable one and demonstrating the associated savings opportunity.

Impactable MemberHigh-Risk Member
Previous Cost: $500Previous Cost: $2,500
Cost After Intervention: $200Cost After Intervention: $2,350
Savings Opportunity: $300Savings Opportunity: $150

In addition to the total cost of care, impactability scores can be used to drive any type of benefit or metric a health plan is targeting, including total cost of care, risk adjustment score, quality ratings, reimbursement rate, and more. At its heart, impactability analysis scores members based on the expected level of benefit to that member, ensuring that the cost of the intervention does not outweigh the benefit.

There are two components to impactability –

  1. An engagement score or likelihood for a member to engage in the healthcare intervention, and
  2. An impact score or likelihood for a member to benefit

Together, the impactability analysis provides valuable insights into who will most likely use a program and what the likely benefit will be for those engaged members. By predicting the impact, health plans have the opportunity to direct effort and attention to the members who both need it most and will take advantage of the intervention while achieving a positive return on investment. And a low score doesn’t mean the health ignore those members but is an indication that they may want to pursue a different intervention/approach with them.

Impactability Scoring Works

Community Care of North Carolina performed some of the earliest research into impactability. In short, CCNC found that,

“…variables related to medication adherence and historical utilization by disease burden proved to be more important predictors of impactability than any given diagnosis or event, disease profile, or overall costs of care.”

Further, CCNC found the potential ROI was two to three times greater than the traditional focus on high-risk patients or high utilizers.

As shown in the chart below, not all high-cost patients have high impactability scores, and not all patients with high impactability scores have high costs.

“Individuals to the right of the vertical bar have an Impactability Score >200, the threshold that Community Care of North Carolina currently uses to prioritize care team outreach. The horizontal bar represents the equivalent number of patients on the cost scale: if prioritization were based strictly on high-cost/high-needs criteria, care management would be deployed to the people above that line.”

Likewise, Softheon is demonstrating the efficacy of its impactability model and showing strong results in terms of our ability to accurately predict the members who will engage. For example, Softheon worked with a Blue Cross plan that sought to ensure its reimbursement accurately reflected the risk of its Medicare Advantage population. As we wrote in a success story published in December 2021,

“The number of patients with hierarchical condition categories (HCC) that would affect risk adjustment did not align with the predictive analysis of the population – the disconnect was attributed to a lack of a Centers for Medicare and Medicaid Services (CMS) qualifying visit for risk adjustment based on CMS standards.”

The health plan chose Softheon to:

  • Step 1: Help them determine which members to target for an annual wellness visit and how to engage them.
  • Step 2: Create a member activation strategy.
  • Step 3: Quantify the increase in annual wellness visits.

The strategy worked.

Health plan members where outreach efforts were successful saw a fivefold increase in annual wellness visits. That’s because Softheon accurately identified the members likely to engage and used that information to personalize the outreach to those members, enabling the plan to more effectively influence member choice.

The future of impactability analysis is even more promising.

Artificial intelligence (AI) and analytic approaches will help health plans manage programs across the care continuum. Even more importantly, they will increase the actionability of impactability scores. To ensure an even greater level of personalization, this intelligence needs to be tied to care teams so they can help members make better decisions at the point of care.

Nasir Ali is the Chief Product Officer at Softheon Technologies. He is a strategic product leader who has worked most of his career at the intersection of healthcare and technology. Nasir leads the product team in developing solutions to influence member choice and helping health plans.

He holds a bachelor’s degree in mechanical engineering in India and a master’s in business administration in Connecticut. He has also completed postgraduate work in product strategy.