Rightway announced enhancements to its risk-scoring technology driven by artificial intelligence (AI) to help identify “rising-risk” and “high-risk” members with greater precision. Rightway is a healthcare company focused on improving care navigation and pharmacy benefits.

Daniel Feller, Ph.D., Director of Data Science at Rightway, said, “We know that proactive, targeted outreach to members of interest is key to closing undiscovered care gaps and avoiding adverse diagnoses and events. Over the last two years, the data science team has been laser-focused on improving our analytics capabilities to better identify members with chronic health risks. Now our health guides are equipped with an even more powerful tool to serve the members who need it most.”

The advanced system uses clinical and data science experts to develop proprietary machine learning algorithms and artificial intelligence to analyze each patient’s longitudinal medical history. Using AI, Rightway’s clinical staff can engage members of interest earlier and perform proactive outreach. Rightway can better serve its diverse member base with this enhanced offering, especially for members who are currently utilizing care or are at risk of needing healthcare for chronic and/or high-cost conditions.

Paula Bush, EVP of Advocacy Strategy and Delivery at Rightway, added: “‘Rising-risk’ members rarely realize how close they are to developing a serious ‘high-risk’ condition. Now we can help them get to the most appropriate level of care as fast as possible and at the lowest cost. We proactively empower our members to advance on their healthcare journeys: educating them about their conditions, matching them to high-quality experts, providing them upfront costs, and informing them of additional health and wellness benefits available through their employer.”

To enhance healthcare outcomes and reduce health care costs, it is imperative to identify “high-risk” members, especially those with chronic or co-morbid conditions. Approximately 19.6% of the nation’s Gross Domestic Product goes toward treatment for chronic diseases in the United States each year, amounting to $3.7 trillion.

At the same time, chronic diseases like obesity and diabetes often occur alongside other conditions like hypertension, hypertension, and pulmonary disease, increasing the prevalence of co-morbid conditions. The Rightway proprietary scoring tool helps health counselors determine which members will need support more efficiently. Rightway’s innovative algorithm searches the data for members of interest that might be of interest to the clinician.

The company previously stratified members based on claim analytics and health assessments. Rightway’s new machine learning capabilities provide a deeper and more granular understanding of members’ health, giving Rightway’s clinical health guides the right information at the right time to offer care recommendations before adverse events occur, ultimately helping to reduce costs and improve member health and wellbeing.