Uncover hidden opportunities to grow market share, identify retention risks, and maximize member profitability.
Request DemoPinpoint key regions to target for surgical marketing campaigns against high-impact member cohorts.
Elevate retention rates with improvements to member benefits and managed care strategies.
Maximize profit per member per month by finding new ways to refine supplier contracts and streamline claim management.
disenrollment
24.7K
members
$37M
at risk
Our AI agents continuously traverse complex healthcare data to find new opportunities. Gain your competitive edge with insights for choice rate, PCP network strength, member profits, enrollment, and retention.
The Medicaid market is changing rapidly due to post COVID-19 public health emergency redetermination unwinding. All MCOs are experiencing increased competition and cost pressures as a result.
See unique member demographics that are growing most aggressively in specific zipcodes. Refine marketing messaging towards specific plans that benefit those members most.
Patient access to primary care physicians can impact member enrollment and retention trends. Monitor complex internal and external data relationships to make educated decisions on where and when to invest in new facilities.
Preferences are hidden across member engagements, health diagnoses, plan benefits, and external data. Personalize your care plans and outreach efforts based on hidden patterns buried across these complex data relationships.
Dual-eligible in rural SE counties
147 target counties identified
$8.2M potential
MA-eligible with chronic conditions
89 underserved counties
$4.1M potential
Seniors switching from competitor
TX, FL, AZ markets
$3.8M potential
Ranked by estimated enrollment impact
Based on 847K member analysis
Payers struggle with high claims costs, inefficient processing, poorly negotiated supplier contracts, and inadequate management of appeals, all of which inflate costs and reduce profitability. Addressing these issues is crucial for improving financial performance and sustaining growth.
Unsupervised AI helps identify specific demographics, diagnoses, claim types, and supplier contracts that are particularly lossy, making it easy to spot the highest leverage areas for margin improvements. It also flags bottlenecks in appeals and grievances processes, enabling teams to investigate and optimize these areas.
By quickly identifying unprofitable situations, MCOs can leverage data-driven insights to explore re-negotiations with state programs. Each re-negotiation is supported with clear data themes showing where suppliers or service providers are more costly than expected.
Plan transitions are critical events when data visibility, administrative costs, churn, and member education are all impacted negatively. These transitions also cause shifts in regulatory compliance requirements. Addressing these issues quickly is essential for a smooth transition and to maintain payer profitability.
Unsupervised assists in increasing visibility as members transition from plan to plan as various life events occur. Knowledge of who is switching, why they're switching, and where educational efforts need to be improved can be used to increase member lifetime value.
Stay on top of shifts in cost structure and changes in provider networks to ensure consistent access to care.
1.2K high-value aging in · Est. $11M capture opportunity
Verified Result
$58M
found in first 6 months
Patient Impact
60M+
beneficiaries impacted
Data Integration
26
data sources merged
This case study explores how a Fortune 500 healthcare payer used Unsupervised AI to uncover $58M in potential improvements to member growth and retention programs within just six months.
$58M
in opportunities found in 6 months
26
datasets joined
60M+
beneficiaries
Learn how AT&T discovered significant opportunities in their data.
Our comprehensive approach to enterprise data security.
How a major payer found member growth and retention opportunities.
Quickly identify and understand performance metric shifts.
Get started with Unsupervised in minutes. Get a full team of AI Agents producing insights, answers, and predictions for your team.
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