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.


Penetration in Reinsurance market.


Penetration in First Dollar insurance market.


Americans will have some level of stop loss coverage in addition to their primary insurance.


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