The financial gravity of healthcare is increasingly concentrated in a small but rapidly evolving segment of patients: high-cost claimants. For employers and health plans, this group represents one of the most urgent financial risks in benefit management.
New therapies, changing oncology paradigms and an expanding drug pipeline, especially for rare diseases, are reshaping the definition of high-cost members. At the same time, advances in machine learning-based risk prediction models enable organizations to be more proactive in planning benefit strategies and care coordination for these individuals.
