Fractal Health Triage enables personalized and coordinated care to payer’s Medicare members 
Fractal Health Triage enables personalized and coordinated care to payer’s Medicare members 
4 min. read

Fractal Health Triage enables personalized and coordinated care to payer’s Medicare members 

The big picture

A Fortune 100 health plan faced challenges with disjoint clinical care plans targeted to its members. This fragmented approach, delivered by different internal teams, resulted in costly and reactive care, ineffective coordination, and a confusing experience for the members. 

To address these challenges, we deployed Health Triage, an Azure-based end-to-end care management solution, in the client’s environment. Health Triage helped identify and prioritize members with urgent critical health needs. It then tied them to appropriate health actions or care plans and helped deliver personalized and coordinated healthcare experience.  


The client used multiple clinical models to predict acute In Patient (IP) admits, high-cost members, chronic condition progression, readmissions, ER visits, and more.  

There were corresponding intervention plans aimed at managing the health of members based on models. However, these models were not integrated, resulting in a lack of a unified view of the members’ health and disjointed clinical interventions directed toward them.  


Recognizing the need for a more cohesive approach, the client needed a solution that could enable personalized and coordinated clinical care for its members with urgent needs. 

In response, Fractal deployed Health Triage to identify and prioritize members with the most acute care needs. Health Triage also helped pinpoint the right health actions or gaps in care to be addressed and prioritized members based on urgency, engagement, and actionability. 

The solution made it simple to have a comprehensive view of both the ongoing current interventions and the health actions required. This enabled a more personalized member healthcare experience.  

Health Triage allowed a multidisciplinary care team of nurses, doctors, pharmacists, and others to effectively identify members needing immediate attention. It gave them a deeper understanding of each member’s care needs, enabling them to deliver the most appropriate healthcare interventions. 

Fractal Health Triage enables personalized and coordinated care to payer’s Medicare members 

The five pillars of the Fractal Health Triage solution 

Health Triage leverages five functional pillars to build a unified experience for each member: 

  • Stratification: Segments member population into different risk cohorts based on their health risks and needs. 
  • Identification: Predictive models, clinical triggers, and data-driven triggers to identify members-at-risk who are likely to have a health event or need an intervention. 
  • Prioritization: Ranks members and their interventions based on their urgency, impact, and feasibility. 
  • Personalization: Tailors the outreach strategy and the messaging for each member based on their preferences, demographics, and social factors. 
  • Roster and monitor: Integrates the insights from the previous modules into the care management solution and enables the care team to reach out to the members, monitor their progress, and provide feedback.  

Health Triage also integrates a Power BI layer for insights management and reporting. 

It also uses a continuous feedback loop for model enhancement and to improve solution performance. 

The deployment of Fractal Health Triage enabled the client to collaborate effectively across various healthcare teams by providing a unified, central view of each member’s clinical history.  

Additionally, it offered insights into various factors like social, lifestyle, and environmental elements that could influence the health of each member. 


Everybody wants faster and better results. Automation aims to reduce time and enhance members’ experience and outcomes. Health Triage’s highly modular and scalable Azure-based solution made these objectives a reality. It allowed for continuous enhancements to analytical components and rules. 

  • The solution removed siloed operations and enabled coordinated and personalized care delivery at scale. 
  • The solution could identify about 5,000 new members every week for personalized care interventions. 
  • The solution optimized processes resulting in an 80% reduction in time to identify members and drive targeted interventions. 
  • A comprehensive member profile was constructed using multiple datasets to form a 360-degree view of each member. This allowed for efficient scaling and further enhancement of the solution. 
  • It led to members having a more positive perception of their payer.  
  • With improved access and quality of care, responsiveness, chronic condition management, customer service, and preventive care, the client witnessed improved members’ satisfaction ratings. 

The drive towards integrated care was important to deliver the best healthcare service to members. Health Triage brought in a unified experience, connecting members and the healthcare team in a simplified manner.  

This initiative not only enhanced member satisfaction but also contributed to an increase in the number of days members experienced good health. Finally, it also improved the healthcare team’s understanding of each member’s health needs.