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Turning care management
analytics into action

Personalizing member engagement for better 
outcomes and lower costs

Download the white paper

Reactive care is costing payers and providers

Health care costs across the U.S. keep rising, straining patients and payers alike. Traditional care management programs concentrate resources on members already flagged as high-risk—an approach that arrives too late, after the window for cost-effective intervention has largely closed.

At the same time, regulatory mandates for data transparency and interoperability are accelerating, and members increasingly expect experiences that are personalized, convenient, and proactive. Generic outreach that ignores cultural preferences, language barriers, and health disparities fail to engage the people who need care most.

The opportunity is clear: extract more value from your data to shift from retrospective reporting to proactive, personalized care management. This white paper shows healthcare organizations how to make that shift, and what it delivers.

What you'll learn

01
<p><strong>Predictive modeling that identifies rising risk early</strong></p><p>Advanced analytics and machine learning predict which low- and medium-risk members will transition to high-risk within the next 24 months. This extended window gives care teams the time to act meaningfully and prevent or delay disease progression, rather than reacting once complications escalate.</p>
02
<p><strong>Care management analytics built for value-based care</strong></p><p>Analytics have evolved from basic reporting into a sophisticated capability. By aggregating clinical data, claims, pharmacy records, and drivers of health, payers can stratify populations by current and future risk, then deploy targeted, prescriptive interventions that improve the precision and effectiveness of every strategy.</p>
03
<p><strong>Drivers of health and equity as a business necessity</strong></p><p>Social and cultural factors shape outcomes, adherence, and access to care. The white paper details strategies for reducing inequities—culturally adapted communication, targeted resource allocation, and cultural competency at every level of care—that improve outcomes while reducing costs.</p>
04
<p><strong>Personalized member engagement that members act on</strong></p><p>Personalized outreach reaches members through their preferred channels, matched to their health literacy and cultural context. When members feel outreach is relevant to them, they move from passive recipients to active participants in their own care</p>

From the front lines of care management

"Partnering with EXL helped us move from retrospective reporting to predictive care management. We can now identify rising-risk members up to 24 months earlier and target interventions that deliver significant savings per member annually, while improving outcomes and experience."

—VP, Care Management, Michigan health insurer

"EXL's ability to understand member behavior, preference, and risk helped personalize our engagement strategies and changed the trajectory of our programs. We saw a 10% lift in engagement and a 15% improvement in care gap closures because members felt the outreach was relevant to them."

—Director, Coordinated Care Operations, Michigan health insurer

FAQs

What is care management analytics?
<p>Care management analytics integrate data from clinical records, claims, pharmacy utilization, and drivers of health to create a holistic view of member health. They use predictive and prescriptive modeling to spot patterns, forecast risk, and recommend targeted interventions that improve outcomes and lower costs across entire populations.</p>
How does predictive modeling identify rising-risk members?
<p>Machine learning analyzes clinical risk factors, demographic and cultural data, behavioral insights, pharmacy and lab data, and increasingly wearable device data. It identifies members currently in low- or medium-risk categories who are likely to become high-risk within 24 months, giving care teams time to intervene early.</p>
How does personalization improve member engagement and the patient experience?
<p>Personalized engagement reaches members through their preferred channels, in their preferred language, and with content matched to their health literacy and cultural context. When outreach feels relevant, members participate more actively—Michigan payer saw a 10% lift in engagement and a 15% improvement in care gap closure.[</p>
What ROI can payers expect from care management analytics?
<p>In EXL's actuarially validated partnership with a Michigan health insurer, the program delivered $2,000 to $3,650 in annual per-patient savings across managed rising-risk cohorts, a 15% gain in care gap closure, a 10% lift in engagement, and fewer emergency room visits, inpatient admissions, and readmissions.</p>
How do drivers of health factor into care management?
<p>Drivers of health—the conditions in which people are born, grow, work, live, and age—significantly affect outcomes, adherence, and access to care. Incorporating these factors into predictive models helps identify at-risk members earlier and supports culturally appropriate interventions that reduce disparities and cost.</p>
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