This application applies evidence-based clinical rule sets and advanced mathematical processes to claims, membership and other data (lab, health risk assessment, etc.) to identify high-risk members and rank them by need.  Use these clinically-based forecasts to allocate resources efficiently and intervene before adverse outcomes occur and dollars are spent. Results are presented in an easy-to-use web interface. A few mouse clicks generate a list of members with diabetes and a profile of Impact Opportunities - areas that provide the greatest potential for intervention and management. Standard reports present clinically-relevant data about expected inpatient, pharmacy, and ER use, along with total expense projections.

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Risk Navigator Performance incorporates retrospective utilization profiling and risk information. Provider performance can be measured against national and regional benchmarks. Key information includes Case Mix Index, Efficiency Index, and Episode evaluation of potential savings.

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Risk Navigator Financial provides actuarial and underwriting reporting functionality, cost predictions, and modeling flexibility. Historical trends in cost, utilization and risk by group and renewal date, combined with predictive capabilities, make this a very powerful tool for Actuarial and Underwriting teams.

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Risk Navigator Provider provides clinicians and/or office managers with the ability to retrieve information for a specific patient, obtain a list of all patients' evidence-based medicine compliance, and review utilization performance. Disease and diagnosis reports at aggregate and individual patient levels are also available.

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Risk NavigatorReporter provides additional ad-hoc reporting capabilities for each module via the Cognos Powerplay Product