As the costs of healthcare services in the United States continue to grow, healthcare payers and employer sponsors of self-funded health plans find it increasingly challenging to offer competitive health benefits to their plans’ members without increasing employee contributions or cutting benefits. This paper identifies several approaches that health plan sponsors and payer organizations currently use to predict plan members who are at risk of being high-cost claimants. Our discussion includes the following sections: 

• Why is predicting high-cost plan members important
• Why it’s difficult
• Some common approaches to predicting high-cost members