that “proactive” programs that
address the other 50% of cost also positively impact participant
satisfaction. We offer a wide array of medical management
programs that can be used separately or fully-integrated. These
include:
Wellness and Prevention:
Participants have access to a user-friendly and effective self-care and
prevention web site that features a health risk assessment, self-care
guidelines, an integrated patient health record, medical and
prescription drug information and evidence-based treatment
evaluations. This program also features an integrated 24/365
nurse line and automated distribution of reminders and health hints.
Health Coaching:
Participants can call or request a call from health coaches that can
assist them with gaining a greater understanding of managing health
conditions or gain assistance with weight loss, smoking cessation or
other healthy behaviors.
Disease Management/Compliance Management:
Using sophisticated data mining and predictive modeling tools we can
identify patients that are at risk for more serious conditions due to
one or more diagnoses and/or failure to comply with the treatments for
their conditions. Once identified, those at risk can be managed
through a range of approaches including correspondence, educational
materials, outbound calls and more comprehensive counseling.
Precertification: Traditional
management of hospital admissions has been supplemented with
prospective review of ambulatory surgery, high cost diagnostic tests,
medical equipment and other targeted procedures and services.
Case Management:
Patients with severe and costly conditions are handled by Case Managers
that monitor treatment plans for opportunities to improve care and
reduce cost. Efforts are made to involve the family and to
maintain the continuity of care among the multiple providers typically
involved. The Case Managers also coordinate transition care as
well as educating the family on community resources that may be
available.
Focused Condition Management:
Several programs are available to manage conditions that significantly
impact cost, including cancer, end-stage renal disease and any
condition where specialty drugs are used.
While every program may not be feasible for every
employer we know that the tools must be available to take every
opportunity to gain a healthy and productive workforce.
