West coast in-home care payvider

Reduced hospitalizations among high-risk populations with predictive analytics

Measurable impact

This west coast in-home care payvider's innovative population health analytics, powered by MedeAnalytics, substantially reduced hospitalization rates below the national averages for its Medicare patients.

reduction in ER visits
reduction in admissions
reduction in readmissions

The story behind the numbers...

The Challenge

This west coast in-home care payvider came to MedeAnalytics with a few central business objectives:

  • Address vulnerable populations
  • Reduce hospitalizations for target groups
  • Segment population groups for effective care management

They also had big goals for growing analytics and reporting capabilities, including determining "impactable" populations for interventions, aggregating data for patient stratification and cost analysis, and obtaining actionable insights about vulnerable patient populations.

  • Leading, risk-bearing provider of field-based complex care for vulnerable populations
  • Delivers high-touch, individualized care
  • Uses predictive analytics to identify high-risk and rising-risk patients for in-home care delivery
  • Addresses the social determinants of health, including transportation, social isolation, cognitive impairment, behavioral health and palliative care

The Solution

MedeAnalytics’ Population Health solution enables this client to stratify risk and to assess cost and utilization patterns in the population to identify appropriate areas for intervention. More specifically, they:

Use predictive analytics to impact the most complex 5% of the population and address rising risk in up to 20% of the population.

Proactively look at Cost and Utilization patterns to identify and prioritize care and interventions for the patients who are the most vulnerable and most at risk.

Categorize data by assigning Adjusted Clinical Groups (ACGs) to each patient based on morbidity, age and sex.


Presbyterian is already working on plans to further their predictive and optimization analytics with MedeAnalytics innovative solutions.

“We were able to significantly decrease unnecessary utilization for an entire population with MedeAnalytics’ predictive analytics.

The insights allow [our] home-based care team to intervene with patients to slow down disease progression and keep them safely out of the hospital, while uniquely addressing their myriad of complex care needs.”

Chief Clinical Officer at this in-home care payvider on the West Coast

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