Government Programs

Data-Driven Risk Insights for Healthcare Payers

Government programs like Medicare Advantage and Managed Medicaid face the dual challenge of providing high-quality care while managing resources effectively. Verikai’s analytics solutions offer a pathway to refine these objectives, with a focus on predictive risk modeling, cost management, and improved patient outcomes driven by medical and prescription history as well as social determinants of health (SDOH) .

Boost your underwriting accuracy with our data solutions:

Risk Management for Patient Populations

Utilize our deep analytics to gain a preemptive understanding of patient risks. By identifying potential health issues before they become critical, you can guide beneficiaries towards better health outcomes and more efficient use of healthcare services.

Cost Efficiency

Our predictive models are essential tools for managing the economics of healthcare. By forecasting potential high-cost areas and suggesting interventions, our solutions help maintain budgetary balance and reduce financial waste.

Our reports offer a granular view of
potential risk.

Population Health Report

Delivers insight into a cohort’s social determinants of health and actionable preventative health suggestions for the group.

Medical and Pharmaceutical Analysis

Offers insight into medical and pharmaceutical risks for a cohort. It includes risk scores, diagnosis and prescription history for the last three years, high-cost condition and drug insights, and identification of the highest risk individuals.

Risk Score

Provides insight into the relative risk of individuals or groups compared to a standard based on age, gender, and location. It includes scores for overall risk, claim risk, and profitability. Scores include 3 years of medical and pharmaceutical history on the group, social determinants of heath, and behavioral attributes.

Expected Claims

Provides insight into a group’s total expected claims and the primary medical drivers of those claims.

Managed Medicaid programs

Managed Medicaid programs can apply our insights to streamline care coordination, manage chronic conditions effectively, and achieve better health outcomes for their populations.

Medicare Advantage plans can use our data to structure benefits that precisely align with beneficiary profiles, manage population health, and ensure sustainable plan offerings.

Discover how our analytical tools have transformed risk management and cost containment for government health programs, leading to substantial improvements in patient care.

Case study

Example of carrier

Provides insight into a group’s total expected claims and the primary medical drivers of those claims.


The Transformation of CMS Underwriting: A Shift Towards Predictive Modeling

Learn about the paradigm shift in CMS underwriting towards predictive modeling, how it is changing the industry, and what underwriters need to know to stay ahead.


Redefining Risk Assessment: The Role of Social Determinants of Health in Stop Loss Underwriting

Learn how considering social determinants of health can provide a more holistic risk assessment.

Ready to unlock the full potential of your healthcare data? Contact us for a demo and see our products in action.

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