High-Cost Member Management

Members with frequent admissions and ED visits are easy to identify. They often have several specialists, recent transitions and social needs that make them hard to reach consistently.

Case managers are among the most skilled people on a plan’s team. Their time goes furthest on clinical judgment, not on the routine check-ins that keep a member engaged between those conversations.

ZynPredict identifies members whose utilization and clinical signals indicate a rising trajectory — not just the members already in high-tier case management, but the members approaching that threshold. The Predictive Activation Agents initiate outreach for rising-utilizer members before the next admission, capturing medication status, identifying social barriers, and routing concerns to the case management team with full context.

For members already enrolled in complex case management programs, the Chronic and Longitudinal Care Management Agent maintains the routine monthly outreach cadence — confirming medication adherence, checking for new symptoms, reinforcing care plan components, and identifying barriers that need case manager attention. The case management team receives escalations from the routine contact rather than owning the contact volume itself.

For health plan care management and medical management teams, the change is in how caseload hours are distributed. Case managers spend their time on the high-judgment interventions. The routine contact volume that keeps members engaged between those interventions runs through the Zynix AI workflow.