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Unique Intelligent Analytical Model

Unique Intelligent Analytical Model

This unique and innovative intelligent analytical model is used for identifying patients with patterns of uncoordinated care and quantifying the cost of uncoordinated care in a population. This model is very different from a model which identifies super utilizers or high cost patients. Conversely, the objective of this model is to identify avoidable costs related to uncoordinated care independent of the total cost of care for a patient.

This model utilizes our proprietary CareSync and Medication Risk Scores for identifying specific patients with patterns of uncoordinated care and quantifying the cost of uncoordinated care in a population. Significant cost savings have been demonstrated using this model in health plans.

Uncoordinated Care Analysis Findings from Multi-state Study:

  • Patients were screened for patterns of uncoordinated care, for over and under utilization of prescriptions, therapeutically duplicative and contraindicated drugs, frequently changing drug therapies within class and subclass, using multiple prescribers and multiple pharmacies concurrently and in random patterns, accessing the ER frequently and/or for non-emergent care, and numerous other access patterns often indicative of uncoordinated care.
  • Astoundingly, in all states analyzed these extreme uncoordinated care patients represented less than 10% of patients yet accounted for an average of 45% of drug costs, over 30% of medical costs and over 35% of all drug and medical costs combined for the population. 
  • Overall these extremely uncoordinated care patients had average annual pharmacy costs that were seven times greater, and average annual medical costs that were four times greater, than those that were in the more coordinated group.
  • Even when patients were matched into like comparison groups by severity of illness scores, major disease, number of co-morbid conditions, and demographic characteristics, the cost differences remained very significant between the two groups.
  • Uncoordinated care patients had average annual total costs of $15,100 Vs $3,116 for those with better coordinated care in the remaining population.


The findings of our multi-state comprehensive claims analyses provide compelling evidence that effective cost avoidance measures are readily available and can be implemented in conjunction with care/disease management and medication therapy management programs if the focus is first appropriately narrowed to a small percentage of the targeted population who are accessing care in an uncoordinated and inefficient manner.

Institute of Medicine Publication on Cost of Uncoordinated Care