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Member Risk Stratification Agent

Scores every member for admission and utilization risk using claims and clinical history, refreshed as new data lands.

Who it's for
Payer care management and population health analytics teams.
What it replaces
Manual risk review used to target care management outreach.
<div class="hx-demo-box" style="margin-top:40px;border:1px solid #D2D2CA;border-radius:12px;overflow:hidden;background:#fff;box-shadow:0 12px 32px -12px rgba(23,25,21,.18)"><div style="background:#F7F7F3;border-bottom:1px solid #D2D2CA;padding:10px 20px;display:flex;align-items:center;gap:10px"><span style="width:11px;height:11px;border-radius:50%;background:#E4E4DE"></span><span style="width:11px;height:11px;border-radius:50%;background:#E4E4DE"></span><span style="width:11px;height:11px;border-radius:50%;background:#E4E4DE"></span><span style="font-size:12px;color:#8B9086;margin-left:6px">payerops.local/risk/panel-view</span></div><div style="padding:22px 22px 6px"><div style="font-size:11px;letter-spacing:0.06em;text-transform:uppercase;color:#585D54;margin-bottom:14px;font-weight:600">Panel distribution by risk tier</div><div style="display:flex;align-items:flex-end;gap:18px;height:120px"><div style="flex:1;display:flex;flex-direction:column;align-items:center;gap:8px;justify-content:flex-end;height:100%"><div style="width:100%;background:#D2D2CA;border-radius:6px 6px 0 0;height:74%;animation:fadeUp .3s ease both"></div><span style="font-size:12px;color:#585D54">Low &middot; 64%</span></div><sc-if value="{{ r2 }}"><div style="flex:1;display:flex;flex-direction:column;align-items:center;gap:8px;justify-content:flex-end;height:100%"><div style="width:100%;background:#E8D889;border-radius:6px 6px 0 0;height:44%;animation:fadeUp .3s ease both"></div><span style="font-size:12px;color:#585D54">Moderate &middot; 22%</span></div></sc-if><sc-if value="{{ r3 }}"><div style="flex:1;display:flex;flex-direction:column;align-items:center;gap:8px;justify-content:flex-end;height:100%"><div style="width:100%;background:#E0554F;border-radius:6px 6px 0 0;height:24%;animation:fadeUp .3s ease both"></div><span style="font-size:12px;color:#8A2E29;font-weight:600">High &middot; 14%</span></div></sc-if></div></div><sc-if value="{{ isDone }}"><div style="margin:16px 22px 20px;padding:14px 16px;border-radius:8px;background:#FCEFED;font-size:13px;color:#8A2E29;animation:pop .4s ease both">Member #70144: 3+ chronic conditions, 2 ED visits in 90 days, risk score 82. Routed to care management worklist.</div></sc-if></div>
window.HX_DEMOS=window.HX_DEMOS||{}; window.HX_DEMOS["mrs"]=function(Base){ const CYCLE_SEC=8; class Comp_mrs extends Base { state={t:0,name:'',email:'',org:'',formSubmitted:false}; componentDidMount(){ this._start=Date.now(); this._iv=setInterval(()=>{ if((Date.now()-this._start)/1000>=CYCLE_SEC){clearInterval(this._iv);return;} const t=((Date.now()-this._start)/1000)%CYCLE_SEC; this.setState({t}); },150); } componentWillUnmount(){clearInterval(this._iv);} onName=(e)=>this.setState({name:e.currentTarget.value}); onEmail=(e)=>this.setState({email:e.currentTarget.value}); onOrg=(e)=>this.setState({org:e.currentTarget.value}); submit=()=>this.setState({formSubmitted:true}); renderVals(){ const t=this.state.t; return {r2:t>=0.8,r3:t>=1.8,isDone:t>=3, name:this.state.name,onName:this.onName,email:this.state.email,onEmail:this.onEmail,org:this.state.org,onOrg:this.onOrg,submit:this.submit, formOpen:!this.state.formSubmitted,formSubmitted:this.state.formSubmitted,nameSuffix:this.state.name?', '+this.state.name.split(' ')[0]:''}; } } return Comp_mrs; };
Score your own membership →
Free to start. No credit card.

How the Member Risk Stratification Agent works

1
Ingests claims and clinical history
Ingests claims and clinical history
Pulls the member's claims history and available clinical data.
2
Scores admission risk
Scores admission risk
Applies a risk model to estimate the likelihood of hospitalization or high utilization.
3
Segments the population
Segments the population
Groups members into risk tiers for care management targeting.
4
Step label
Refreshes on new data
Recalculates scores as new claims and encounters post.
5
Step label
<1 sec
to score a member on new claims data
Daily
refresh as claims and encounters post
3 tiers
segmented for care management targeting

Target the members who actually need outreach.

Start free, we'll score a sample of your real membership so you can see the tiers.

Scored against your actual claims and Rx data
Feeds directly into your care management worklist
Free to score your first 1,000 members
Starts free
Takes about 30 seconds. No sales deck required.
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