OptMyCare stop loss reinsurance is a one stop comprehensive tool for clinical review, underwriting advice and deductible estimations. Proprietary scalable algorithms and clinical review team can accurately predict annual healthcare costs in patients who are at risk for high-dollar claims. Accurate and timely underwriting decisions are often needed to win new business and renew existing business. Assessments made on old or stale data is often less accurate and actionable.
OMC shines a beam of light on the current clinical risk picture and the most reliable cost estimate associated with the current clinical status when determining if an individual can be accepted at the current group spec or retention or require a laser.
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
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.
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.
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.
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.
– 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.