Both Medicaid and Medicare Advantage plans focus on ensuring the most effective care but face hurdles on the way. The vulnerable populations under Medicaid plans are already facing delayed care, missed diagnoses, lack of preventive services, and other outcome-related issues due to structural inequities and biases, which contribute to high healthcare spending. On the other hand, Medicare Advantage plans need to enable value-based care contracts to ensure their resources are well-targeted and effectively spent. All this ultimately affects HEDIS, star ratings, and the associated resources.

Plans and providers need a one-stop solution to address these disparities using reliable data on all plan members (active and inactive), relevant social determinants of health, and associated risk scores to make pre-emptive, cost-effective decisions. HealthEM.AI uses AI-enabled technologies to identify high-risk individuals and assist with disease diagnosis, identify changes in a patient’s medical state, and tailor timely interventions with the right infrastructure, collaborations, and buy-in from clinicians and patients.