Get Smart About Benefits Enrollment and Beyond
For the Member:
Personalized recommendations driven by past claims data to ensure members have the right coverage for their family’s healthcare needs.
For the Employer:
Educate employees on available healthcare benefits, potential financial contributions and more to cultivate a healthy and productive population
For the Payer:
Tools like the Reclaim app boost member loyalty, strengthen member engagement and increase group satisfaction through ongoing financial advising
VBA Partnership Profile
Get to Know Reclaim
What is Reclaim? Reclaim is a data-driven healthcare financial wellness application that helps health plan members manage the entire financial spectrum of their healthcare. Whether at open enrollment or year-round, Reclaim helps plan members manage their healthcare bills, plan for care, and select the right health plan for their needs, all with the power of the member’s data at work.
How does Reclaim’s enrollment decision support work?
- Reclaim analyzes a plan member’s claim history and matches others with a similar healthcare journey in the past.
- Using those past healthcare journeys, Reclaim projects the future healthcare needs of the plan member, including care utilization and total cost.
- Reclaim applies the eligible benefits to the member’s project utilization to predict their out-of-pocket cost under those benefits.
- Based on these projections, Reclaim ranks the benefits options and produces an optimal bundle that is completely personalized to the plan member.
How is machine learning/artificial intelligence involved?
- Mapping demographic features of users to those with similar indicators and similar healthcare journeys to predict future healthcare utilizations
- Overlaying healthcare benefit design to the predicted healthcare utilizations to predict expenses and provide an optimized and customized benefits bundle
- Ongoing analysis of plan utilization to learn and fine tune the predicted healthcare needs over time
What information does Reclaim’s enrollment decision support take into account?
- Healthcare benefit design
- Set of eligible benefits
- Demographic information
- Historical healthcare claims data
What are ongoing features for plan members? Reclaim empowers plan members to make informed financial decisions with ongoing engagement with their benefits in the context of their own claims and bills. The app will produce alerts for a variety of events, such as incoming healthcare bills, HSA/FSA transactions, telemedicine alternatives and more.
What differentiates Reclaim from its competitors? Reclaim provides truly personalized and optimizes benefits communication at open enrollment and beyond. Because Reclaim aggregates medical and pharmacy bills across carriers, employees still have access to their history in one place, and new claims from new carriers will flow seamlessly into the system members are used to. Finally, Reclaim can minimize the need for members to rely on patient advocates or benefit managers, especially for low to medium complexity bills.