Innovator’s Corner

Innovation

Real-Time, SaaS-Based, Heath Plan Performance Management System With Fully Integrated Communication Outreach Campaigns to Targeted At-Risk Subgroups

Problem Addressed

Employers are continually looking for ways to keep health care benefit plan spending under control. One way to do this is to better manage the “morbidity risk” of the underlying employee/family populations. Ten plus years ago employers thus began to analyze the combined data from the various health care–related programs such as medical, prescription drug, wellness, care management, and so on. The idea was and is to mesh the information together so as to identify opportunities to reach out to targeted subgroups of plan members who are at risk, mis-utilizing services and so forth.

Employers have heretofore been using expensive, data warehouse–based claims analysis systems to identify at-risk populations within the health care plan. However, these “legacy-technology” systems produce only after-the-fact, monthly reports, which are then typically discussed with external advisors to decide on required actions. This causes a 2 to 3 month lag. When action plans are implemented, they often address only the low hanging fruit due to complexity, logistical considerations and related expense. They do not address all risks and all problems. The results can be a lower-than-need-be level of plan member campaign engagement and, thus, limited employer savings.

Innovation

This innovation is a SaaS-based analytical engine that integrates all desired health care data in real time. Positive financial results are often realized in the first year and employers, consultants, and plan members now have immediate access to their data in the form of easy-to-use dashboards, workflows, predictive analytics, and plan change simulators (i.e. the data is not “locked up”/restricted within a flat, singular report). This single system not only identifies and predicts the problems, it goes on with no lag to manage fully-integrated systematic outreach campaigns. Targeted sub-group member campaigns are continuously identified, prioritized and developed on line. Nurses and other advisors run incentive -driven engagement campaigns on a HIPPA compliant basis with attendant ROI / value add measurement - by campaign. These campaigns target and engage the right employees at the right time so as to drive down total health care cost.

Return on Innovation (ROI)

Participation rates in Disease Management programs alone are as much as 45%, which is 9 times the industry average. The ROI will depend on what actions have already been taken by the employer but can be as high as 15 to 1 or more. One medical device manufacturer realized an 18 to 1 ROI, for example.

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