Predict & Prevent Primary Claims
“The Coaching Choice”
1. Splashlight’s predictive analytics will accurately identify and stratify the high risk and rising risk individuals using three years of historical health claims and workers’ compensation claims. They use the first two years of data to build the model and the third year to prove validity. While many vendors promise a reduction in cost of the highest-cost or highest-risk segment, they recognize that this cohort regresses to the mean, and a demonstration of effectiveness requires showing savings after making a “dummy year adjustment” to account for that regression effect. Splashlight will contract to show savings validly, taking that adjustment into account.
2. Prior to beginning their Prevent services, Splashlight provides a benchmark of predicted future medical costs for health claims and workers’ compensation medical claims. Using their validated predictive analytics methodology they then adjust for those ICD10 codes that are mutually agreed with their clients to be impactable through their prevention services. They will apply measures that are attributable to The Coaching Choice solutions which they expect to result in a reduction of overall costs by at least 5%.
3. Splashlight’s contractual language and outcomes reporting will be transparent and plausible. All research limitations (e.g., “participants vs. non-participants” or the “natural flow of risk” or ignoring dropouts) and methodology will be fully disclosed, sourced, and readily available.
4. Splashlight will measure the actual savings realized each quarter and annually and adjust their savings totals accordingly to show the total costs and savings for the client. Further they will guarantee in their contracts that their costs will not exceed more than 40% of the actual savings achieved over a three year period. If the actual annual savings have not exceeded annual costs after a six month period to adjust for delays in claims received, then Splashlight will continue to provide services at no charge for up to an additional year or until the actual savings are realized through validated measures.
5. The participant experience will be tracked for all participants with the following expectations:
80 percent of the identified population will participate in The Coaching Choice program.
80 percent of participants in The Coaching Choice program will report their willingness to recommend the program to others.
80 percent of participants in The Coaching Choice program will report their improved confidence in their ability to manage their healthcare.
80 percent of the participants in The Coaching Choice program will report that it improved their quality of life.
80 percent of the participants in The Coaching Choice Program will report positive personal experience as a result of participation.