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    • Home
    • Who We Help
      • Healthcare
      • Insurance
      • Private Equity
      • Other Industries
    • What We Do
      • Data & AI Solutions
      • How to Engage OPSTIFY™
    • Client Impact
      • Client Impact
    • About
      • About OPSTIFY™
      • Databricks Partnership
      • Snowflake Partnership
      • What we Think
      • Community
  • Home
  • Who We Help
    • Healthcare
    • Insurance
    • Private Equity
    • Other Industries
  • What We Do
    • Data & AI Solutions
    • How to Engage OPSTIFY™
  • Client Impact
    • Client Impact
  • About
    • About OPSTIFY™
    • Databricks Partnership
    • Snowflake Partnership
    • What we Think
    • Community

Value-Based Care - Next Best Action Intelligence

 OPSTIFY™ engineered a Value-Based Care Analytics Engine that moves beyond risk identification to prioritize high-opportunity patients, next-best actions, and limited care-management capacity. 

CARE MANAGEMENT PRODUCTIVITY

CARE MANAGEMENT PRODUCTIVITY

CARE MANAGEMENT PRODUCTIVITY

Focus Capacity Where Intervention Matters Most 

QUALITY & UTILIZATION

CARE MANAGEMENT PRODUCTIVITY

CARE MANAGEMENT PRODUCTIVITY

Move From Risk Identification to Earlier Intervention 

VBC FINANCIAL PERFORMANCE

CARE MANAGEMENT PRODUCTIVITY

VBC FINANCIAL PERFORMANCE

Connect Intervention to Value-Based Economics 

The Enterprise Mandate

Knowing Who Is High Risk Isn't Enough. Know Where to Act.

Risk stratification can identify thousands of high- and rising-risk members, but it does not tell a care-management team who should be prioritized today, what intervention is most appropriate, or where limited clinical capacity can create the greatest impact. 

Complexity

Population of 20,000 attributed members,including approximately 3,000 high-risk and 5,000 rising-risk members and a team of only 15 care managers.

Not feasible to investigate every opportunity manually. 

The challenge was to transform risk intelligence into prioritized, actionable intervention intelligence. 

From Risk Score to Next Best Action

HIGH-OPPORTUNITY IDENTIFICATION

CONVERSATIONAL CARE INTELLIGENCE

HIGH-OPPORTUNITY IDENTIFICATION

Focused the POC on a defined Medicare Advantage cohort to identify patients where targeted intervention could address avoidable readmission risk. 

CONDITION-SPECIFIC INTELLIGENCE

CONVERSATIONAL CARE INTELLIGENCE

HIGH-OPPORTUNITY IDENTIFICATION

Applied focused intelligence to Diabetes and CHF populations, connecting patient risk with relevant clinical conditions and care opportunities. 

NEXT-BEST-ACTION PRIORITIZATION

CONVERSATIONAL CARE INTELLIGENCE

CONVERSATIONAL CARE INTELLIGENCE

Mapped prioritized patient opportunities to structured interventions; from specialist follow-up and diabetes education to transportation and other care-management actions. 

CONVERSATIONAL CARE INTELLIGENCE

CONVERSATIONAL CARE INTELLIGENCE

CONVERSATIONAL CARE INTELLIGENCE

Enabled care-management leaders to explore prioritization data and investigate patient cohorts conversationally without waiting for new reports or technical queries. 

See Next-Best-Action Intelligence in Action

Watch the VBC AI Assistant. Built by OPSTIFY™ on Databricks

 See how care leaders can move from a high-risk population to specific patients, intervention priorities, and actionable next steps through conversational intelligence. 

Business Impact

High - Opportunity Patient Identification

High - Opportunity Patient Identification

High - Opportunity Patient Identification

Isolate the patients with the greatest intervention opportunity and deliver structured Next Best Actions care managers can immediately execute. 

Care Management Capacity

High - Opportunity Patient Identification

High - Opportunity Patient Identification

Automatically prioritize daily patient lists so limited care-management capacity is directed toward patients where intervention has the greatest potential impact. 

Avoidable Utilization

High - Opportunity Patient Identification

Multi-Year Path to Scale

Identify actionable care opportunities earlier to target interventions designed to reduce avoidable readmissions and unnecessary utilization. 

Multi-Year Path to Scale

High - Opportunity Patient Identification

Multi-Year Path to Scale

Established the foundation for Patient 360, intervention tracking, outcomes measurement, and ROI intelligence. 

Capabilities Applied

Data + AI Strategy
Data Engineering & Integration
Semantic Foundation
Decision & Predictive Intelligence
AI Assistants / Conversational Intelligence
Consumption-Layer Strategy & Execution
Value Based Care starts after the Risk Score

Complexity

 OPSTIFY™ moves beyond identifying risk, connecting high-opportunity patients to prioritized interventions, scarce care-management capacity, and measurable outcomes. 

Related Client Impact

$37B National Health Payor - Foundational Data Transformation

$37B National Health Payor - Foundational Data Transformation

$37B National Health Payor - Foundational Data Transformation

Read Case Study

$3.5B Provider Health System - Analytics Modernization

$37B National Health Payor - Foundational Data Transformation

$37B National Health Payor - Foundational Data Transformation

Read Case Study

Healthcare Provider & Payor - Value Based Care Intelligence

$37B National Health Payor - Foundational Data Transformation

Healthcare Provider & Payor - Value Based Care Intelligence

Read Case Study

Your Risk Scores Identify the Patient. What Happens Next?

Turn risk stratification into prioritized intervention intelligence that helps care teams determine who to act on, where to focus limited capacity, and what action to take next. 

Identify Your Opportunities

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