HealthBenIQ — AI-Native Population Health Analytics

The Challenge

The Cost of Inaction Is Measured in Billions

Legacy analytics stacks report on the past. Your members need action today.

59%

of Americans skip recommended preventive screenings

Only 8% of adults receive ALL recommended preventive services, leaving massive gaps in care quality.

Source: Aflac 2024; Health Affairs

26%

of members with care gaps drive 39% of future health spend

Unmanaged rising-risk members become high-cost claimants within 12–18 months without intervention.

Source: Springbuk

84%

of benefits consultants report point solution fatigue

Legacy analytics stacks cost $8–15 PMPM with siloed outputs and no action layer.

Source: Tendo 2024

Humana’s 2024 Star Rating drop cost ~$3B in lost bonus payments and erased $4B in market cap in a single day. Can your organization afford to wait?

The Platform

Seven Dashboards. One Command Center.
Zero Data Silos.

Purpose-built analytics for every stakeholder — from the CMO to the care manager — all drawing from a single source of truth.

Executive Overview

KPI command center with AI-generated narrative insights across all domains.

CMO · VP Quality

Risk Stratification

5-tier risk model with rising-risk intervention triggers and cost predictions.

Care Management

Utilization Management

ED, inpatient, readmission trends with network leakage detection.

Utilization Review

Care Gap Detection

32 HEDIS measures with AI-enriched gap closure recommendations.

Quality · HEDIS Teams

Network Performance

Provider scorecards, referral patterns, and panel capacity analysis.

Network Management

Financial Analytics

PMPM trends, medical loss ratio tracking, and cost-of-care cohort analysis.

CFO · Actuarial

Population Health

Demographic segmentation, social determinants, chronic disease prevalence.

Population Health

health.healthbeniq.com/home

Features

Built for Action, Not Just Analysis

Every feature is designed to move from insight to intervention — automatically.

Core IP

32 HEDIS Measures. Deterministic Detection. AI Enrichment.

Our care gap detection engine implements 32 HEDIS MY2024 measures across 7 clinical domains — not as probabilistic guesses, but as deterministic SQL logic running against your claims data.

✓ Deterministic SQL detection — no false positives from ML guessing
✓ AI enriches each gap with member-specific closure recommendations
✓ Star Rating projection with measure-by-measure breakdown
✓ Results feed directly into outreach automation

Preventive Chronic Behavioral Medication Pediatric Women’s Health Access

AI Engine

AI Surfaces What Matters — Before You Ask

Our AI insights engine analyzes your entire population nightly and surfaces what’s changed, what’s at risk, and what to do about it. Then ask any question in plain English.

✓ Severity-tiered insights: Critical, Warning, Informational
✓ Natural language Q&A — no SQL required, no analyst ticket
✓ Star Rating projections and what-if modeling
✓ Every insight links to an actionable drill-down

Predictive

Catch Rising Risk Before It Becomes High Cost

Our 5-tier risk model identifies members who are becoming expensive — not just those who already are. When a member enters the Rising tier, outreach triggers automatically.

● Low — Healthy, preventive care current
● Moderate — Minor chronic conditions, stable
● Rising — Emerging risk, intervention window open
● High — Multiple chronic conditions, active utilization
● Complex — Poly-chronic, behavioral + social complexity

Outreach Engine

Three Channels. One Intelligent Cadence.

From gap detection to closed loop — fully automated. AI generates personalized outreach per member, per gap, across email, SMS, and AI voice with automated follow-up sequences.

Email AI-generated personalized HTML templates with open/click tracking

SMS 160-char optimized messages with direct scheduling links

AI Voice Real conversational AI with objection handling — not a robocall

Campaign management with conversion funnel analytics

Automated follow-up sequences with quiet-hours compliance

287%

higher engagement with multi-channel vs. single-channel outreach — TeleVox, 2025

Enterprise Security

Healthcare-Grade Data Protection

Built into every layer — not bolted on after the fact.

🛡

HIPAA-Ready Architecture

📜

BAA Available

🔒

Envelope Encryption

🛠

Tenant Isolation

Multi-Tenant Data Isolation

✓
Dataset-per-tenant isolationEach client’s PHI resides in a dedicated data warehouse dataset with no shared tables or cross-tenant query paths.
✓
Envelope encryptionTenant-specific encryption keys managed via dedicated key management; keys never leave the cloud boundary.
✓
Tenant-scoped API routesEvery API request validated against JWT tenant claim; cross-tenant access is architecturally impossible.
✓
Materialized views per tenantQuery acceleration without exposing underlying row-level data across organizations.

Zero-Trust Access Control

✓
JWT authenticationEnterprise identity provider issues short-lived tokens with embedded tenant and role claims.
✓
Multi-factor authenticationPhone-based SMS verification for all privileged roles; enrollment enforced at onboarding.
✓
7 granular rolesFrom super_admin to care_manager — each with precisely scoped data and feature access.
✓
PHI masking by roleMember identifiers and clinical narratives dynamically redacted based on user permission tier.
✓
Full audit trailEvery data access, query, and configuration change logged with identity, timestamp, and action detail.

Pricing

Enterprise Capability at a Fraction of Enterprise Cost

Transparent PMPM pricing. No hidden fees. No long-term lock-in.

HealthBenIQ Analytics

$1.00 PMPM

Core analytics platform for population health intelligence.

✓ 7 interactive dashboards
✓ AI-generated insights & natural language Q&A
✓ Care gap detection — 32 HEDIS measures
✓ Star Rating projections & what-if modeling
✓ Multi-tenant security & encryption
✓ Unlimited users & queries

Recommended

HealthBenIQ Analytics + Outreach

$1.50 PMPM

Full platform with AI-powered member engagement.

✓ Everything in Analytics, plus:
✓ AI-powered Email, SMS & Voice outreach
✓ Campaign management & audience targeting
✓ AI voice agent for live gap closure conversations
✓ Outcome tracking & conversion analytics
✓ Automated follow-up sequences

	Legacy Stack	HealthBenIQ
PMPM Cost	$8 – $15	$1.00 – $1.50
Implementation	6 – 12 months	6 weeks
Action Layer	None	AI Outreach Built-In
Annual Cost (100K members)	$9.6M – $18M	$1.2M – $1.8M
Savings		85–90% reduction

ROI

Measurable Return. Provable Value.

Three scenarios that demonstrate why the platform pays for itself in weeks, not years.

Star Rating Improvement

$2.4M

16x return

Close 500 care gaps to unlock +0.25 Star improvement. 4+ Stars = 5% benchmark bonus = ~$600/member/year in additional revenue.

Rising Risk Intervention

$840K

5.6x return

Intervene on 200 rising-risk members before escalation. 20% lower hospitalizations, 40% fewer readmissions, $4,200 average cost avoided per member.

Outreach Gap Closure

$1.2M

8x return

AI outreach to 1,000 members with open care gaps. 15% closure rate via Email + SMS + Voice, plus downstream cost avoidance.

$4.4M

Total Year 1 Value

$1.5M

Platform Investment

3x

Combined ROI

< 2 Wk

Payback Period

Implementation

Six Weeks to Live

No professional services fees. No consultants. No 12-month project plan.

1

Weeks 1–2

Connect

Sign BAA and DPA. Provision tenant environment. Connect claims, eligibility, and clinical data feeds.

2

Weeks 3–4

Configure

Activate HEDIS measures. Configure risk models, Star Rating weights, user roles, MFA, and PHI masking rules.

3

Week 5

Validate

Run care gap detection across full population. Review AI insights with clinical leadership. Validate against benchmarks.

4

Week 6

Launch

Go live with all users. Activate outreach campaigns. Begin real-time monitoring. Dedicated CSM assigned.

Get Started Today →

From Population Data
to Patient Action.

The Cost of Inaction Is Measured in Billions