HEALTH CARE MANAGEMENT: CHALLENGES & OBJECTIVES
Health care starts with understanding the health status of each person and discovering how to help them improve their well-being, and how best to get their medical needs met. If we reduce sickness, costs go down. While many companies work at this, after intensive research we found one company, HealthCare Strategies (HCS), has better demonstrated results than other providers and has the capacity to handle our many members.
HOW IT WORKS
This program starts with storing patient data on an integrated platform system that allows staff to manage, maintain and restore the health of your members. The goal is to perform various types of intervention with the purpose of allowing each and every member to improve or restore maximum health while reducing medical costs for the plan.
The backbone of the program is a Population Health Risk Analysis (PHRA). This is a clinical predictive modeling technology, which allows the stratification of the population for various interventions to begin to assist members with their health issues. Data is extracted from claims to identify medical and pharmacy issues, health risk assessments, biometric screenings and lab results.
Service stemming from the PHRA analysis includes:
- Coaching / Care Management At risk members receive coaching from RNs to help them make better health choices and decisions.
- My HealthReach Workbook A secure online health record where members can store health information e.g., prescriptions, lab results notification of recommended preventive testing, standards of medical care and notification of potentially harmful drugs.
- Healthy Start Available through the HealthReach Workbook, offers specializes online classes to motivate and inform members toward a better lifestyle. Includes availability of a Health Coach by internet or phone.
- Preventative Care Identifies evidence based care gaps through the review of medical charts and notifies the patient and their primary physician when two or more gaps are identified,
- Pharmacy Review Determines if members have drug-drug interactions, duplicate therapy, and informs on dosage alerts and noncompliance issues. Letters are sent to physicians as a precautionary measure.
- Advocate The program identifies a unique HEDIS standard for each month and notifies patients affected by the failure to have that standard met.
- Medical information Helpline Provides access to a registered nurse 24 hours a day, 7 days a week.
- MaterniCare Registered Nurses work one on one with expectant mothers while providing education and support to help promote a healthy pregnancy and delivery.
- Large Case Management (LCM) Specialist manages members with the most complex and catastrophic medical conditions that are generally responsible for a health plan’s greatest costs.
- Care Counselor Utilization Management (UM) URAC Accredited program is designed to verify treatments and provide alternatives to control costs.
VALUE ADDED
The ROI for this program is measured at an average of 3:1, and the cost is built into the administrative fee, which is modest.
But an additional important reason for your buy-in is your members and their families will be helped to better health and your members will have more productivity, fewer sick days, less presenteeism and less disability.