OMC Solutions for Stop-Loss & Reinsurance
Optimizing the Identification, Stratification and Treatment of All Chronic Conditions~
OptMyCare streamlines data and efficiently identifies high-risk, high-cost claimants, revolutionizing how stop-loss and reinsurance carriers deliver accurate estimates within tight deadlines.
Supporting risk- bearing entities in identifying, stratifying, and managing high-risk, high-cost cases.
- Efficient: OMC’s highly efficient data platform takes the clinical expertise associated with individualized case reviews and applies it on a large-scale, cutting costs and saving valuable time.
- Accurate: OMC’s platform increases the accuracy of diagnosis and even helps identify claimants that have yet to be diagnosed, giving underwriters information they would not have had in the past.
- Clinically Driven: OMC’s analytics were developed by a team of certified medical experts with firsthand experience in fields most-impacted by high-cost claims.
- Optmycare facilitates your in – place team of risk review: By working closely with on-site professionals such as pharmacists, social workers, and billing specialists, OMC is positioned to assist your team of risk reviewers in resolving the most complex cases in a matter of hours. OMC will empower your underwriting and claims review processes, helping your team make the right business decisions.
25%
Penetration in Reinsurance market.
15%
Penetration in First Dollar insurance market.
40m
Americans will have some level of stop loss coverage in addition to their primary insurance.
30%
Clinical reviews that would require stop loss underwriting.
Imagine increased predictive accuracy among highest-risk populations
Risk Stratification/Cost Prediction
Self-Insured Applications include our ability to accurately analyze and stratify risk levels into four distinct categories: ultra-high, high, moderate, and low risk potentials.
Leveraging ML for Accuracy
The OMC platform is unique in that the analytics are underpinned by years of proven clinic experience and are supplemented/refined through machine learning (ML) processes.
Client Benefits
Clients get a secure server with their members uploaded with risk and cost prediction information through our C-suite service option. Cost outlier members within a group would be manually reviewed, and lasers would be posted.
Risk Mitigation / Cost Control
The OMC platform allows underwriters to accurately mitigate risk through targeted application of rate increases, lasers, and other underwriting and pricing tools to groups with identified ultra-high and high-risk individuals.
5 percent of the population accounts for 45 percent of total healthcare costs.
Optmycare Kpi's
– Accuracy rates average 78-92% on predicting cost for an entire cohort at a disease level across multiple risk levels.
– High accuracy in the correlations between disease risk and claims cost.
– 48- to 72-hour turnaround for cost and disease risk analysis.
We harmonize and leverage historical data for renewals and new claims and provide the clients access to that on a subscription basis. Our cloud-based platform allows underwriters and reviewers to access our results remotely without any delay in the underwriting process.
Actionable insights for stop-loss risk mitigation
