Outcome-Based Insurance Platform
Value-based care models with predictive health analytics
Key Results
Client Overview
An innovative health insurer pioneering value-based insurance models:
- 5M+ enrolled members
- $8B+ premium under management
- Medicare Advantage and commercial plans
- Network of 50,000+ providers
- Pioneer in value-based care contracts
Challenges Addressed
Fee-for-Service Limitations
Traditional model incentivizing volume over value, leading to rising costs without improved outcomes.
Limited Member Engagement
Members not participating in wellness programs or following care plans, leading to preventable complications.
Data Fragmentation
Health data scattered across claims, EMRs, wearables, and labs with no unified member health view.
Risk Stratification Gaps
Inability to accurately identify high-risk members before they develop costly conditions.
Provider Alignment
Difficulty implementing shared savings models and measuring provider quality and outcomes.
Outcome Measurement
Lack of standardized metrics to measure and reward health improvements vs. just cost reductions.
Project Timeline
| Phase | Duration | Activities | Deliverables |
|---|---|---|---|
| Strategy & Design | 5 Weeks |
| VBC Program Blueprint |
| Analytics Platform | 12 Weeks |
| Health Analytics Engine |
| Member Platform | 10 Weeks |
| Member Engagement Platform |
| Provider Tools | 8 Weeks |
| Provider Collaboration Suite |
| Launch & Scale | 5 Weeks |
| Program Go-Live |
Solutions Delivered
Predictive Health Analytics
AI models predicting health risks, disease progression, and intervention opportunities using claims, clinical, and lifestyle data.
Member Wellness Platform
Personalized health journey with goal tracking, challenges, rewards, and seamless wearable integration for continuous monitoring.
Outcome-Based Pricing Engine
Dynamic premium calculation based on health engagement, biometric improvements, and achieved outcomes instead of just demographics.
Provider Value Dashboard
Real-time visibility into quality metrics, patient outcomes, and shared savings performance for network providers.
Project Team Composition
Total team size: 26 professionals
Results Achieved
20% Premium Reduction
For engaged members
30% Better Outcomes
Measurable health improvements
45% Engagement Rate
Active wellness participation
25% Cost Reduction
Lower medical expenses
40% Fewer Hospitalizations
Preventive care impact
4.5 Star Rating
Medicare quality rating
Client Testimonial
"Viprata helped us reimagine health insurance from a pure risk business to a health improvement partnership. Our members are healthier, our providers are engaged, and our business model is sustainable. This is the future of health insurance."
Chief Innovation Officer
Innovative Health Insurer
Viprata Software Services
www.viprata.com • [email protected] • +1 (916)-412-2232
For more information about this case study or to discuss your transformation journey, please contact us.
Outcome-Based Insurance Platform
Value-based care models with predictive health analytics
The Client
An innovative health insurer pioneering value-based insurance models:
- 5M+ enrolled members
- $8B+ premium under management
- Medicare Advantage and commercial plans
- Network of 50,000+ providers
- Pioneer in value-based care contracts
The Challenges
Fee-for-Service Limitations
Traditional model incentivizing volume over value, leading to rising costs without improved outcomes.
Limited Member Engagement
Members not participating in wellness programs or following care plans, leading to preventable complications.
Data Fragmentation
Health data scattered across claims, EMRs, wearables, and labs with no unified member health view.
Risk Stratification Gaps
Inability to accurately identify high-risk members before they develop costly conditions.
Provider Alignment
Difficulty implementing shared savings models and measuring provider quality and outcomes.
Outcome Measurement
Lack of standardized metrics to measure and reward health improvements vs. just cost reductions.
Project Timeline
Strategy & Design
Activities
- Value-based model design
- Outcome metrics definition
- Provider engagement strategy
- Technology assessment
Deliverables
VBC Program Blueprint
Analytics Platform
Activities
- Member health data lake
- Risk stratification models
- Outcome prediction algorithms
- Quality scorecards
Deliverables
Health Analytics Engine
Member Platform
Activities
- Member health portal
- Mobile wellness app
- Wearable integration
- Rewards and incentives
Deliverables
Member Engagement Platform
Provider Tools
Activities
- Provider performance dashboard
- Care gap alerts
- Shared savings calculator
- Quality reporting
Deliverables
Provider Collaboration Suite
Launch & Scale
Activities
- Pilot program launch
- Member enrollment
- Provider onboarding
- Performance monitoring
Deliverables
Program Go-Live
Our Solution
Predictive Health Analytics
AI models predicting health risks, disease progression, and intervention opportunities using claims, clinical, and lifestyle data.
Member Wellness Platform
Personalized health journey with goal tracking, challenges, rewards, and seamless wearable integration for continuous monitoring.
Outcome-Based Pricing Engine
Dynamic premium calculation based on health engagement, biometric improvements, and achieved outcomes instead of just demographics.
Provider Value Dashboard
Real-time visibility into quality metrics, patient outcomes, and shared savings performance for network providers.
Project Team
The Results
20% Premium Reduction
For engaged members
30% Better Outcomes
Measurable health improvements
45% Engagement Rate
Active wellness participation
25% Cost Reduction
Lower medical expenses
40% Fewer Hospitalizations
Preventive care impact
4.5 Star Rating
Medicare quality rating
Viprata helped us reimagine health insurance from a pure risk business to a health improvement partnership. Our members are healthier, our providers are engaged, and our business model is sustainable. This is the future of health insurance.
Ready for Your Transformation Journey?
Let's discuss how we can deliver similar results for your organization.