Key Insights
Multi-Phase Analytics Suite
Key Insights
Actionable findings from population analysis
Insights partially unavailable
Key Findings
Action:
Risk Alerts
members affected
Total Members
in analysis population
Total Cost
$
medical reimbursement
Avg Cost/Member
$
per member per year
Risk Stratification Pyramid
members (%)
% of costs
Rising Risk Snapshot (baseline cost floor applied)
Rising members
Avg pct change
Total cost increase
$
| Beneficiary | Prior Cost | Current Cost | Change | Comorbidity |
|---|---|---|---|---|
| No rising-risk members meet the baseline thresholds. | ||||
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Baseline floor applied to avoid low-cost noise; showing paged results from top 50.
Predicted High-Cost (Next-Year Proxy)
Total candidates
High band members
Avg risk score
| Beneficiary | Risk Score | Band | Pred Cost Band | Current Cost | Comorbidity |
|---|---|---|---|---|---|
| No predicted candidates available. | |||||
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Heuristic score blends current cost z-score (60%) and comorbidity load (40%).
Multi-Modal Fusion Coverage
Linked members
Rx linkage rate
Polypharmacy high rate
Condition Prevalence (Fused)
- Diabetes:
- Hypertension:
- CHF:
- COPD:
Match Quality Breakdown
| Stratum | Members | Avg Expense | Avg Encounters |
|---|---|---|---|
| No fusion data available. | |||
Rx Adherence (Phase 2.5)
Avg PDC •
| Member | Class | PDC | Paid |
|---|---|---|---|
Encounter Intensity (Phase 2)
Avg IP | Avg ED
| Patient | Total | IP | ED | OP | Tier |
|---|---|---|---|---|---|
Therapy Gaps (Condition → Missing Therapy)
Members:
| Member | Condition | Gap | Severity |
|---|---|---|---|
Fused Risk Candidates
| Member | Score | Cost Z | Comorbidity | PDC | Util Tier |
|---|---|---|---|---|---|
Condition Cost Impact (Comorbidity-Adjusted)
| Condition | Prevalence | Avg Cost With | Avg Cost Without | Adjusted Impact | Multiplier |
|---|---|---|---|---|---|
* Adjusted impact controls for comorbidity overlap. Negative values indicate condition is associated with lower costs when controlling for other factors.
High-Cost Condition Combinations
No high-cost combinations detected for this year.
Cost Concentration (Pareto Analysis)
costs from top 1%
costs from top 5%
costs from top 20%
Geographic Variation
Mean Avg Cost
CV
Min Avg Cost
Max Avg Cost
Highest Cost States
| No high-cost outliers detected. | ||
Lowest Cost States
| No low-cost outliers detected. | ||
Year-over-Year Trends
| Year | Total Cost | Avg Cost | Members |
|---|---|---|---|
| No trend data available. | |||
Top Opportunities
Therapy Gap
Low Adherence
High-Risk Cohort
Fused cost + adherence + utilization
Data Quality Note
Costs shown use dim_beneficiary.total_medreimb as source of truth. Carrier claims (~33% of costs) are not included in claim-level detail. See DATA_QUALITY_REPORT.md for full documentation of limitations.