Why Early Visibility Matters

Proactive plan management enables better prioritization, benefit alignment, and outcomes. While high cost events can feel unexpected, they often start with subtle indicators—changes in pharmacy use, shifting care patterns, or worsening chronic conditions [1][2].

Using PAI Analytics®, alongside Milliman Advanced Risk Adjusters (MARA®), gives brokers and HR leaders clearer visibility into emerging risks, potential cost drivers, and priority populations. MARA is platform independent and can be incorporated into existing analytic environments (including visualization within current reporting platforms), while PAI Analytics provides the data unification, benchmarking, dashboards, and automation that turn insights into action [1][2][3].

Confidence • Clarity • Control: Move from reactive reporting to a data driven, proactive risk strategy. [2]

MARA in Plain Language

Most traditional reporting looks backward—summarizing what has already happened. MARA shifts organizations toward a forward looking model by analyzing both medical and pharmacy claims to estimate a member’s future expected healthcare needs, not just past costs [1]. This gives you earlier insight into rising risk and potential cost drivers before they fully materialize.

What MARA Does
MARA applies advanced actuarial models to unify a member’s medical and pharmacy claims, creating a prospective prediction of future utilization and cost patterns. This allows plan managers to understand where risk is trending—not just where it has been [1]. This helps brokers/agents and HR leaders identify priority members, understand cost trajectories, and allocate resources more strategically by providing .

• Prospective risk scores estimating likely future costs

  These scores help organizations anticipate where spending may increase by quantifying each member’s expected future healthcare needs based on current and historical indicators [1].

• Risk insights across major service categories (e.g., inpatient, outpatient, ER, pharmacy) for granular transparency

  Break projected risk into key areas of utilization to highlight which services are most likely to contribute to future spending trends [1].

• Complexity indicators to highlight clinically complicated high risk members

  These measures identify individuals whose conditions or care patterns suggest higher clinical difficulty or management complexity, helping teams prioritize support for those who may need it most [3].

Using PAI Analytics, Enhanced with MARA
By shifting the focus from hindsight to foresight, teams gain the ability to intervene earlier, plan more effectively, and support members before risks escalate.

Using PAI Analytics, enhanced with MARA risk indicators, teams can move beyond static reporting and begin taking proactive steps rooted in anticipated trends rather than historical summaries [1][2]. These combined capabilities provide a structured, early warning view of emerging needs across a population, such as: 

• Spot early rising risk patterns, such as specialty pharmacy escalation or avoidable ER use. Early visibility into subtle but meaningful shifts helps teams intervene before costs accelerate or care patterns become entrenched [2].
• Identify members likely to incur higher costs early enough to intervene proactively. Prospective indicators highlight future cost drivers rather than reflecting only past utilization, enabling earlier, targeted outreach [1].
• Act on trend trajectories rather than waiting for lagged claims cycles. Predictive models reduce the dependency on retrospective claims that may be 60–120 days old, helping teams respond closer to real time [2].
• Communicate trends clearly to leadership and clients via self service dashboards and automated reporting. Visualization and automation make it easier to share insights, align stakeholders, and support confident decision making [2].

This approach transforms teams from passive observers of past events into proactive managers of future risk, enabling structured, timely action that supports better outcomes and smarter resource allocation [1][2].

Risk Stratification That Makes Prioritization Clear

Effective population management depends on knowing not just who is high risk today, but who is becoming high risk—and why. MARA strengthens this process by organizing members into meaningful risk tiers and enriching those tiers with deeper context, such as service category level insights and indicators of clinical complexity [1]. This structure gives teams a clearer, more actionable picture of where attention is needed most.

What you gain:
A clear, scalable way to direct resources where they will have the greatest impact—supporting smarter interventions, reducing unnecessary spend, and ensuring teams don’t stretch themselves too thin across low value activities [1][2].

Turning Insights Into Action

Predictive models and risk scores only create value when they lead to meaningful action. PAI works with you to transform raw signals—rising costs, shifting utilization, increasing clinical complexity—into clear direction for benefit strategy, vendor management, and member support. With early visibility into population trajectories, teams can take informed, timely steps that improve outcomes without adding administrative burden [1][2]. This section illustrates how organizations can translate insight into practical, measurable next steps.

1. Targeted Care Management: Use MARA® risk and complexity indicators to identify and prioritize members who may benefit most from care management outreach. These prospective insights ensure support is focused where it can make the biggest difference.

2. Benefit Strategy Aligned to Emerging Trends: As early trend indicators surface, they point to areas where benefit design adjustments can strengthen support and reduce avoidable spend [1][2].

    

   Musculoskeletal risk rising → review imaging steerage, PT access, navigation

   Metabolic risk increasing → reinforce diabetes or weight management supportData helps determine which benefit adjustments may be most impactful [1][2].

3. Vendor + Network Optimization: Use early trend signals to determine where vendor support is most needed and where network performance may merit review. This allows teams to direct partners toward areas of increasing risk or strategic importance [2].
4. Purposeful Wellness Strategy: Align wellness initiatives with demonstrated population needs and adjust based on measurable outcomes. Predictive signals guide which wellness programs deserve expansion, refinement, or deeper promotion [2].
5. Support for Affordability Reviews + Documentation: Earlier visibility into trajectory can support plan sponsors’ internal review processes by helping quantify risk patterns and cost expectations; final compliance determinations remain with the sponsor [2].

Quick Wins for Your First 30 Days

Getting started doesn’t require overhauling workflows or launching multiple initiatives. Small, focused steps help teams build early wins and learn how predictive signals inform practical action. These simple activities help establish a proactive rhythm that integrates into existing responsibilities without overwhelming teams [1][2].

1.    Review rising risk patterns in under five minutes [2].
2.    Shortlist 5–10 members for next step evaluation [1].
3.    Choose one focused action aligned with plan strategy [2].
4.    Track a simple KPI (e.g., outreach completion rate) [2].
5.    Reassess and refine next month [2].

Repeatable rhythm: Predict → Stratify → Act. Small steps build momentum [1][2].

Why Forward Thinking Teams Choose PAI 

Organizations that combine predictive analytics with structured risk stratification gain actionable clarity that helps them manage populations more confidently and efficiently. While experiences vary by population and configuration, many teams report improved ability to identify rising trends early, communicate insights clearly, and prioritize where their resources will have the greatest impact—all without promising clinical or financial outcomes [1][2].

Organizations using this combined approach often see:

• Earlier visibility into risk and trending cost drivers [1].
• More precise population targeting and prioritization [2].
• Clear, defensible reporting for leadership and clients [2].
• Opportunities to support members earlier in their risk journey [1].
• A consistent framework for continuous improvement [2].

Teams commonly report improved timeliness in outreach and stronger program focus when analytics and self service reporting are in use. Experiences vary by population and configuration [1][2].

See How They Work Together

Understanding how predictive signals support day to day decision making is key to adopting a proactive strategy. These next step suggestions help brokers/agents and HR leaders explore how early visibility can guide prioritization and planning without requiring major workflow changes [2].

Brokers/Agents: Explore configuration options and preview how early trend visibility can support your consulting strategy [2].
HR Leaders: Review early risk signals within your population and identify one data backed priority for the next 30 days [2].

Compliance Reinforcement

To maintain clarity and transparency, it’s important to reinforce how these tools support—but do not replace—clinical judgment or compliance oversight. Analytics surface patterns and population trends, while plan sponsors, providers, and members remain responsible for interpretation and decisions. MARA® is platform independent and can be visualized within existing reporting tools, allowing it to integrate seamlessly with PAI Analytics® [1][3].

Analytics provide insight into risk patterns; interpretation and decisions always remain with plan sponsors, providers, and members. MARA® is a registered trademark of Milliman, Inc. and is platform independent; MARA® risk outputs can be visualized within existing reporting platforms and used in conjunction with PAI Analytics® [1][3].

PAI Analytics® uses de identified and aggregated data where applicable. This material is for informational purposes only and does not guarantee clinical or financial outcomes. References to third party content do not imply endorsement. Plan sponsors remain responsible for compliance determinations [2].

References 
[1] Milliman — MARA® Product Overview: https://www.milliman.com/en/products/mara 
[2] Cedar Gate Technologies — Analytics Platform Overview: https://www.cedargate.com/platform/analytics/
[3] Milliman — MARA® (Platform Independent) Overview Page: https://www.my-milliman.com/en-gb/products/mara