Stop Paying for the Crisis
Your Risk Model Never Saw Coming.
Your highest-risk members already have a 24/7 care team — their families. OutsideINsights operationalizes the 63 million unpaid caregivers who see deterioration days before it becomes an avoidable claim.
Nearly every one has watched families spot the signals of decline days before emergency intervention.
These "missed signals" are the source of your avoidable ER utilization. We capture them.
45 Million Members
No Economically Viable RPM Solution Can Reach.
Rural and frontier populations living beyond reliable broadband and cellular coverage are invisible to traditional RPM platforms. Consumer satellite internet exists — but at $120+/month per patient, it's not viable at scale. And traditional satellite services operate on L-band and S-band frequencies that require clear line of sight to the sky — meaning tree cover, roofing, and terrain block the signal.
The OUTsights Gateway communicates at 400 MHz UHF — a frequency that penetrates foliage, building materials, and terrain without direct line of sight. Combined with patent-pending tri-band failover (satellite, cellular, Wi-Fi), it delivers continuous RPM data from FDA-approved monitoring devices — no broadband required. No dead zones.
Learn more about the OUTsights GatewayExpand Your Addressable Population
Bring RPM to members in rural, tribal, and frontier regions — populations most health plans write off as unreachable because existing solutions aren't cost-effective.
Close the Rural HEDIS Gap
Members without connectivity miss every quality touchpoint. The Gateway makes post-discharge follow-up, medication adherence, and chronic condition monitoring possible anywhere.
Reduce Rural ED Utilization
Rural members default to the ER because there's no monitoring infrastructure. Satellite-resilient RPM catches deterioration before the 100-mile drive to the nearest hospital.
Patent Pending · Tri-Band · Global Access
Satellite + Cellular + Wi-Fi. The device intelligently routes data through whichever band is available — no configuration, no IT staff required on-site.
The Between-Visit Blind Spot
Your highest-risk members see their PCP 2-4 times per year—that's 97% of their life happening outside clinical observation. During this blind spot, symptoms change daily, but your risk models only update at the next claim. The only real-time variables? Standard Bluetooth RPM device data, and the "Human Signal" their family sees every day.
High-cost emergencies happen in the blind spot
Behavioral health crises, medication lapses, and chronic condition drift escalate to ED visits and inpatient stays—your most expensive claims.
Behavioral health crises escalate silently
Members in crisis don't self-report deterioration. By the time families call 988 or 911, you're facing inpatient psychiatric claims.
Follow-up metrics hurt HEDIS & Stars
FUH, TRC, and medication adherence gaps drive down your quality scores—and your revenue. Providers lack tools to document care coordination.
Readmissions and ED overuse cost millions
Post-discharge instability and lack of follow-through lead to preventable readmissions. You pay the price.
Risk models miss dynamic deterioration
Claims-based risk adjustment captures static diagnoses. It misses the functional decline and behavioral drift that caregivers observe daily.
Uncaptured Risk Data
Caregivers observe functional decline (ADLs) and behavioral drift that risk adjustment models miss. Their observations—often the most accurate—go unused.
Objective Vitals + Subjective Context
Why relying on just devices or just claims data isn't enough to prevent emergency admissions.
RPM Device Data
The Objective
FDA-approved Bluetooth devices (blood pressure cuffs, scales, pulse oximeters) deliver raw biometrics — via Wi-Fi, cellular, or satellite-resilient connectivity through the OUTsights Gateway. But numbers alone lack the clinical context to intervene without alert fatigue.
The Caregiver Signal
The Subjective
The family caregiver sees the behavioral drift, cognitive decline, ADL struggles, and medication adherence issues that devices cannot measure—days before a crisis occurs.
The Complete Picture
The Winning Combination
Triangulated context that filters false positives and accurately surfaces your highest-cost members before they generate an avoidable ED or inpatient claim.
The Concordance/Discordance Risk Engine
We don't just ask the member. We ask the member and their caregiver.
Concordance
Both say "Worse"
Validated clinical decline. High-confidence signal for care team intervention.
Discordance
Member says "Fine", Caregiver says "Worse"
Immediate flag for cognitive decline, denial, or behavioral health crisis. Your highest-cost cases identified earlier.
Why You Care: This mechanism filters out "false positives"—a major concern—and identifies high-cost cognitive and behavioral cases before they generate claims.
Real-time drift detection
AI-powered alerts flag deterioration before it becomes a crisis claim
Triangulated signals
Member + caregiver + provider observations create complete clinical picture
Risk stratification
Identify high-risk members before they hit your ED or inpatient units
Audit-ready documentation
Timestamped workflows for quality metric compliance
Post-discharge stabilization
Structured follow-up workflows reduce readmissions
Stars & HEDIS-aligned
FUH, TRC, medication adherence—automatically documented
Crisis escalation protocol
Three-stage escalation prevents BH inpatient stays
Population analytics
Aggregate insights for trend analysis and targeting
The Health Plan Enterprise Advantage
Lower costs, higher quality, and stronger compliance — purpose-built for the complexity of Medicaid MCO and Medicare Advantage populations.
Financial Impact
Reduce Avoidable High-Cost Claims
Prevent the expensive events that drive your medical loss ratio.
Ready to Activate Your Invisible Workforce?
See how OutsideINsights turns caregiver observations into protected margins and improved Stars ratings.
Health Plan Questions About OutsideINsights
- How does OutsideINsights reduce avoidable ED visits for Medicare Advantage health plans?
- OutsideINsights captures caregiver-observed member deterioration via SMS check-ins before it escalates to an emergency. We surveyed 186 first responders, and nearly every one confirmed that families see patient decline days before emergency intervention. By routing these observations through a compliant clinical pathway, OutsideINsights flags high-risk members before they generate ED visits and inpatient claims — your most expensive costs under capitated Medicare Advantage contracts. The platform targets the specific gap that claims-based risk models cannot see: the weeks between appointments.
- Which CMS Star Ratings measures does OutsideINsights support?
- OutsideINsights generates timestamped documentation for post-discharge follow-up contacts that directly support FUH (Follow-Up After Hospitalization for Mental Illness) and TRC (Transitions of Care) HEDIS measures — both weighted CMS Star Ratings components. The platform also captures Social Determinants of Health (SDOH) signals observed by caregivers — supporting the CMS Health Equity Index. For plans preparing for 2028 Star Ratings under V28 risk adjustment rules, caregiver-observed behavioral and functional status data supports more accurate risk documentation and coding opportunities.
- What is the Concordance/Discordance risk engine?
- OutsideINsights triangulates three critical data streams: the member's self-report, objective vitals from Bluetooth RPM devices, and the caregiver's Better/Same/Worse observation. When the data streams align on a negative trend, it signals validated clinical decline (Concordance) — a high-confidence trigger for care team intervention. When the member says 'fine' but the caregiver says 'worse' (Discordance), it flags cognitive decline, denial, or behavioral health crisis — exactly the high-cost cases that claims-based risk models miss until after the ED visit. This engine filters false positives while surfacing your highest-cost members earlier, before they generate a claim.
- How does OutsideINsights support V28 risk adjustment for Medicare Advantage?
- CMS V28 risk adjustment now prioritizes behavioral, functional, and social determinant conditions — exactly what family caregivers observe between visits. OutsideINsights captures these observations as structured, timestamped, attributable documentation. This gives health plan coding and care management teams the evidence needed to support V28 risk codes for behavioral decline, functional limitation, and SDOH — conditions that previously went undocumented because patients didn't report them at clinic visits. The result is more accurate risk scores and a stronger case for risk adjustment revenue under V28.
Urgent: 2028 Star Ratings Alert
The Rules Have Changed.
CMS has shifted HEDIS and STARS weighting from customer service to clinical outcomes.
-0.5 Stars Drop
Could cost your plan millions in annual bonuses.
Time Until Next Survey Cycle
Target: June 2026 Survey Window
Don't Let the "Blind Spot" Cost You Stars
Learn how continuous monitoring closes the gaps that traditional surveys miss.