Risk stratification for Medicare Advantage and regional payers.
Stratify your attributed population by 30-day and 365-day risk. Direct case management and care coordination resources to the members who need them, before the admission, not after the claim.
Trusted by healthcare organizations
HIPAA Compliant
Full BAA coverage
SOC 2 Type II
In development
Peer Reviewed
npj Digital Medicine
Validated
0.807 AUC
The readmission math is straightforward. The targeting is not.
For Medicare Advantage plans, hospital readmissions drive both direct medical costs and downstream quality measure impact. A preventable 30-day readmission represents not just the admission cost, but the cascading effects on Stars ratings, risk adjustment accuracy, and member experience scores.
The challenge is targeting. Most MA plans run care management programs that touch 15 to 25 percent of attributed members. But the highest-risk 5 percent of members drive 30 to 50 percent of total spend. The gap between who you reach and who needs you most is the gap Marqi Index was built to close.
Traditional risk stratification tools, built on claims lags and demographic proxies, identify risk after the fact. Marqi Index uses real-time EHR signals alongside closed claims to identify risk before the admission, when intervention is still possible.
How Payers Use Marqi Index
Precision targeting across the member lifecycle, from prospective identification to post-discharge transition.
Reduce Avoidable Admissions
Identify members at highest risk of 30-day readmission and prioritize care management interventions before discharge.
- Pre-discharge risk identification
- Transition of care prioritization
Case Management Targeting
Replace spray-and-pray outreach with precision targeting based on validated risk scores, improving ROI on care coordination.
- Risk-stratified outreach lists
- Intervention intensity matching
Quality Measure Improvement
Support HEDIS and Stars ratings by identifying members who need specific interventions to close care gaps.
- Readmission rate reduction
- Care gap prioritization
Population Stratification
Stratify your entire attributed population into actionable risk tiers for resource allocation and network planning.
- Monthly risk refresh
- Trend analysis by cohort
Value-Based Contract Support
Identify members likely to impact shared savings or quality bonuses in value-based arrangements with providers.
- ACO population targeting
- Episode management support
Medical Cost Prediction
Forecast high-cost episodes before they occur for budgeting, reinsurance, and care management resource planning.
- 365-day spend prediction
- High-cost member identification
Built for the Data Payers Have
Marqi Index runs on closed claims and structured EHR data you already receive from your provider network. No new data collection required, no integration burden on your providers.
Closed Claims Integration
837 professional and facility claims, 835 remittance, standard X12 formats.
ADT Feed Integration
Real-time admission, discharge, and transfer events for trigger-based scoring.
Care Management Delivery
API delivery to care management platforms, or batch export for existing workflows.
Deployment Timeline
Data Agreement
BAA and data scope alignment (2-4 weeks)
Claims Integration
Data feed setup and validation (4-6 weeks)
Population Scoring
Initial risk stratification of attributed lives (2-4 weeks)
Production Delivery
Ongoing scoring and care management integration
Actionable Risk Tiers
Risk scores translated into care management action levels.
High Risk
Top 10% of population by risk score
- Immediate nurse outreach
- Care manager assignment
- Provider notification
Moderate Risk
10th to 30th percentile
- 48-hour follow-up call
- Care gap closure outreach
- PCP appointment reminder
Standard Risk
Bottom 70% of population
- Standard wellness outreach
- Preventive care reminders
- Digital engagement
Ready to improve your care management ROI?
Schedule a 30-minute call to see how Marqi Index can improve targeting accuracy for your attributed population.