- A member churn model scores every member for the risk of leaving, from claims, service, billing and plan history you already hold.
- Reason codes show what drives each member's risk, such as a service issue, a premium change or a gap in care, so your team can act on the cause.
- A second model ranks which retention offer a valuable member is most likely to accept.
- Scores and drivers can feed a dashboard by region, plan and premium band, so leaders see where members are leaving and where service falls short.
You learn a member has left after they are gone
Most plans see churn in the enrollment file, weeks after the decision was made. By then the member has already chosen another plan, and the retention budget went to members who were never going to leave.
The signals were there earlier. They sit across claims, call center contacts, billing history and plan changes, and the pattern that matters is how a member's recent behavior differs from their own history. A list nobody acts on does not keep anyone; your team needs a score, a reason and a next step for each member, in the channels you already use.
How member churn prediction works
Step 1: Assemble the history
Join enrollment, claims, service contacts, billing and plan-change data for past members, with whether each one renewed.
Step 2: Build and compare models
H2O Driverless AI runs automatic feature engineering that compares recent behavior with each member's own history, and ranks candidate models.
Step 3: Explain each score
Reason codes show the factors behind each member's risk.
Step 4: Choose the offer
A second model ranks which retention offer each at-risk member is most likely to accept.
Step 5: Feed your channels
Scores, reasons and offers go to the CRM, outreach and service tools you already run.
Step 6: Monitor and retrain
Watch for model drift as benefits, premiums and the market change.
Governance for member data
Protected health information never has to leave your boundary; the models can run on-premises, air-gapped, in a private cloud or in the cloud. Your compliance team decides which data may inform an outreach decision.