How Health Triage helps payers deliver smarter, proactive care 

Keeping up with healthcare’s changing demands  

Healthcare payers work in an environment where a small number of members account for most healthcare costs, while expectations for personalized, whole-person care keep growing. Medicare and Medicaid populations, in particular, present complex combinations of chronic conditions, behavioral health needs, and social risk factors that evolve rapidly over time.   

Yet many care management programs still rely on fragmented data, static eligibility rules, and manual prioritization, making it difficult to identify the right members, at the right time, with the right intervention.  

At the same time, payers face growing pressure to improve quality measures (such as HEDIS), reduce avoidable inpatient and emergency utilization, and demonstrate measurable ROI from care management investments. Traditional analytics approaches struggle to keep pace with these demands because they lack a unified member view, cannot operationalize predictive insights at scale, and fail to continuously learn from member engagement and outcomes.  

Health Triage is designed to help payers move from reactive, episodic interventions to a proactive, intelligence-driven care model that continuously adapts to member risk, behavior, and needs.  

Turning data into meaningful insights with Databricks  

Health Triage is built on Databricks, leveraging the Lakehouse architecture to unify, process, and operationalize complex healthcare data at scale. The solution ingests and harmonizes data from medical and pharmacy claims, eligibility, clinical records, provider data, social determinants of health, HEDIS measures, and digital interaction data to create a longitudinal Member 360.  

Using Databricks for scalable ETL, feature engineering, and governance, Health Triage constructs a production-grade feature store with thousands of clinical, utilization, behavioral, and demographic markers. These features power predictive models for avoidable inpatient admissions, readmissions, and high-cost risk, as well as clinically defined triggers that detect early warning signals across populations.  

Databricks ML and workflow orchestration enable these models to be trained, validated, and operationalized directly within care management workflows. Outputs are not limited to risk scores alone. Health Triage translates predictions into prioritized member rosters, ranked gaps in care, and next-best-action recommendations that can be pushed seamlessly into payer care management platforms via APIs. A GenAI layer further enables care teams to interact with complex Member 360 data through intuitive insights and summaries. This accelerates decision-making without adding operational burden.  

How Health Triage works  

Health Triage supports end-to-end care orchestration across five core capabilities:   

• Stratify: Classifies populations into clinically meaningful risk cohorts based on chronic conditions, comorbidities, behavioral health, and utilization patterns.  

• Identify: Uses predictive models and clinical or data-driven triggers to surface members most likely to deteriorate, incur high costs, or miss critical care.  

• Prioritize: Rank-orders members using a composite of risk, intervention impact, and likelihood to engage, ensuring limited care resources focus where they matter most.  

• Personalize: Recommends tailored care plans based on clinical history, lifestyle behaviors, SDOH, communication preferences, and business rules such as do-not-disturb settings.  

• Monitor & Learn: Feeds member responses, outcomes, and engagement back into the platform to continuously refine models, care plans, and outreach strategies.  

  
  

This closed-loop approach ensures insights are not just generated but acted upon and improved over time.  

Health Triage is built to integrate seamlessly within a payer’s environment, sit on existing data, and provide the flexibility and customization needed to meet each organization’s unique requirements.  

Built for real-world impact  

Health Triage is purpose-built to deliver direct, measurable value for payers. By enabling earlier identification of high-risk members and prioritizing interventions with the highest potential impact, payers can reduce avoidable inpatient admissions and emergency visits. They can also improve gap-closure rates and increase the effectiveness of care management teams. In targeted MVP deployments, Health Triage has demonstrated the potential to drive millions of dollars in annual savings through even modest reductions in utilization. It has also improved member engagement and satisfaction at the same time.  

The platform integrates seamlessly with existing payer ecosystems including care management systems, CRMs, and outbound communication tools. It allows organizations to modernize without replacing core systems. Its modular, scalable design supports rapid rollout by line of business (Medicare, Medicaid) and adapts easily to evolving regulatory requirements and clinical strategies.  

For payers seeking to move beyond siloed analytics and manual care coordination, Health Triage offers a practical, Databricks-powered foundation for proactive, personalized, and financially sustainable care management at scale.  

With its data-driven foundation and continuous learning approach, Health Triage helps payers deliver more proactive and responsive care that adapts to member needs over time.  

Click here to learn more about Health Triage or visit our Databricks partnership webpage.