The Right Member, Moment, and Message: How Predictive Outreach is Changing High-Cost Claims

High cost claimants make up about 1% of a typical plan's members, but they account for roughly a third of its spending. Most employers rank managing them as their top health care priority. The trouble is that the standard approaches only flag someone after they cross a dollar threshold or receive a diagnosis, by which point the expensive decisions have usually been made.

In this session, Fereshteh Dastyar, Garner's VP of Strategic Alliances, and Zoe Greenburg, Garner's Director of Product Management, walk through what it takes to reach these members earlier. You'll hear why traditional models identify only about 5% of future high cost claimants, which four kinds of data employers need to predict who is headed toward an expensive episode, and how a doctor's past practice patterns can signal what will happen to a patient who hasn't been diagnosed yet. Zoe follows one member's back pain from her first search to an MRI to show where Garner reaches out, who makes the call, and why the timing changes whether she listens.

Whether you manage a self-funded or fully insured plan, this is a practical look at what predictive outreach involves, how it fits alongside stop loss and Centers of Excellence, and what changes when a high cost claim no longer arrives as a surprise.