🏥 Continuum RM🛡️ RiskFlow🦷 Dental Continuity

Large Claimant Registry

High-cost member exposure tracking • Intervention status monitoring

CRITICAL CLAIMANTS
3
ELEVATED RISK
3
IN INTERVENTION
4
TOTAL EXPOSURE
$1.6M
Member M-1042
critical
in progress
Midwest Regional Health System • 45-54 • family
$380K
Proj: $510K
96
Risk Score
DiagnosisOncology — Hematologic
Pharmacy$145K
Inpatient5
ER4
Velocity6.1/mo
Specific Deductible: $250K152% · Exceeded by $130K
Oncology case managementSpecialty pharmacy reviewBiosimilar evaluationCenter of Excellence referral
Manager: james.wong@apexbenefits.com
Member A-2031
critical
in progress
Heartland Logistics Group • 55-64 • employee spouse
$295K
Proj: $420K
91
Risk Score
DiagnosisCardiology — Ischemic
Pharmacy$98K
Inpatient3
ER6
Velocity4.8/mo
Specific Deductible: $250K118% · Exceeded by $45K
Cardiac case managementSpecialty pharmacy reviewNetwork steerageCenter of Excellence referral
Manager: patricia.nguyen@apexbenefits.com
Member B-7782
critical
identified
Pacific Maritime Industries • 35-44 • family
$412K
Proj: $560K
93
Risk Score
DiagnosisOncology — Solid Tumor
Pharmacy$167K
Inpatient4
ER2
Velocity5.4/mo
Specific Deductible: $250K165% · Exceeded by $162K
Oncology case managementClinical trial referralBiosimilar evaluationPalliative care consult
Manager: marcus.reyes@apexbenefits.com
Member C-3490
elevated
in progress
Lone Star Construction • 55-64 • employee only
$224K
Proj: $320K
84
Risk Score
DiagnosisEnd-Stage Renal Disease
Pharmacy$203K
Inpatient7
ER5
Velocity8.2/mo
Specific Deductible: $250K90%
Dialysis coordinationSpecialty pharmacy reviewTransplant referralCare management
Manager: lauren.petrova@apexbenefits.com
Member D-6615
elevated
in progress
Northeast Healthcare Systems • 45-54 • family
$187K
Proj: $310K
79
Risk Score
DiagnosisNeurology — MS
Pharmacy$189K
Inpatient2
ER3
Velocity3.9/mo
Specific Deductible: $250K75%
Specialty pharmacy reviewBiosimilar evaluationDisease managementCare coordination
Manager: sofia.marchetti@apexbenefits.com
Member E-8841
elevated
recommended
Cascade Food Services • 35-44 • employee children
$142K
Proj: $240K
72
Risk Score
DiagnosisRheumatology — RA
Pharmacy$156K
Inpatient1
ER2
Velocity3.1/mo
Specific Deductible: $250K57%
Specialty pharmacy reviewBiosimilar evaluationSite of care optimizationCare management
Manager: evan.whitfield@apexbenefits.com