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Risk Analytics: Early Detection of Potential Diseases


Healthcare payer in collaboration with a healthcare provider, both based in Pennsylvania

Business Problem

Medical screenings are conducted for early detection of potential health disorders and diseases to ensure risk mitigation


Identify eligible individuals who have not availed medical screening

Abzooba’s Solution:

  • Machine Learning algorithms were used to design clustering mechanisms
  • Identified micro-segments having different medical screening needs
  • Incorporated business rules adhering to HEDIS measures and guidelines
  • SQL and Python libraries were used to create the algorithms
  • Clustering presentations were created using D3
  • The reports were created in SSRS

Business Benefits:

  • Income from the medical screenings, paid by the insurance provider
  • Income from Quality Performance Measure (QPM) incentives awarded on a PMPM (Per Member Per Month) basis
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