Home › Who we serve › Health plans and payers
For health plans and payers
Find rising risk early, across your whole membership.
For Medicare Advantage, Medicaid managed care, commercial plans and third-party administrators. HSRMed shows which members are changing, where care gaps are open, and which outreach is working, region by region.
- Population view by product line, region and risk tier
- Rising-risk lists for care management, refreshed daily
- Care gap support, including kidney health testing for members with diabetes
- Value-based contracts: shared reporting with provider partners
The challenge
Claims arrive months after the problem
Most risk models look backward. By the time a claim appears, the admission has already happened.
Lagging data
Claims and annual assessments show risk long after it started to rise.
Large, spread-out memberships
Care managers cannot call everyone, and rural members are the hardest to reach.
Contracts need proof
Value-based contracts and quality programs need clear, shared measures with provider partners.
Sample screen
Population dashboard
What a care management leader sees: enrollment, engagement, risk tiers and regional performance.
Members by risk tier
Based on each member's change from their own baseline
Members active each month
Members sending data at least once a week
| Region | Members enrolled | Active, 30 days | Rising risk | Outreach completed | Open kidney testing gaps |
|---|---|---|---|---|---|
| North Texas | 6,200 | 81% | 410 | 88% | 640 |
| Central Texas | 4,800 | 77% | 352 | 84% | 590 |
| Gulf Coast | 5,900 | 74% | 498 | 79% | 820 |
| West Texas (rural) | 3,100 | 69% | 301 | 71% | 610 |
| Panhandle (rural) | 1,900 | 72% | 166 | 76% | 270 |
| Border region | 2,700 | 70% | 244 | 73% | 250 |
Numbers are illustrative and do not describe a real plan.
What HSRMed delivers
Built for health plans
Population insights
Membership by product line, region and risk tier, with drill-down to the care management list.
Rising-risk worklists
Members whose trend is moving away from their own baseline, ranked for outreach.
Care gap support
Lists of members missing recommended testing, such as eGFR and uACR for members with diabetes.
Provider partnerships
Shared views with primary care groups in value-based arrangements, with the member's consent.
Rural reach
Engagement and outreach by region, so rural members are not left behind.
Privacy and compliance
Role-based access, audit logs and minimum-necessary data sharing.
How it works
From membership to measurable results
Select members
Choose the populations for the program, such as members with diabetes, heart failure or chronic kidney disease.
Enroll and connect
Members join through the plan or their provider and connect devices in their language.
Prioritize outreach
Care managers work ranked lists; provider partners see their own attributed members.
Report results
Engagement, gaps closed, outreach and utilization, by product line and region.
What you can measure
Measures for plans and contracts
Questions
Questions from health plans
How is HSRMed different from a claims risk model?
Claims show what already happened. HSRMed adds continuous data from members' homes, so a change can be seen while there is still time to act. The two work well together.
Can provider partners see the same data?
Yes, for their attributed members and with the member's consent, so plans and providers work from the same picture.
Which lines of business does it fit?
Medicare Advantage, Medicaid managed care, commercial plans and self-funded plans managed by third-party administrators.
How is the program priced?
Pricing depends on the population and program design. Contact us to discuss a pilot.
Design a pilot for your members
Start with one population and one region, and measure the results together.
Who we serve