If you’re involved in your company’s health insurance plan, you simply can’t rely solely on your Carrier, Third-party Administrator (TPA) or Medical Management vendor to identify and support at-risk plan members.
The fact is, most carriers, TPAs and even medical management firms often lack the initiative to engage in deep health risk management. And it may not be for lack of interest – many of the largest carriers in the country have yet to implement state-of-the-art predictive modeling and risk analysis tools. Consequently, they can fail to engage as much as 80% of your healthplan members who, an independent risk analysis would suggest, should be evaluated for Disease Management, Case Management or Nurse Advocacy services. All of which are structured to save your healthplan money and improve the quality of care received by your employees and their families.
So what can you do to ensure better outcomes from Medical Management?
The most effective action you can take is to work with an independent firm to identify and stratify members into four basic risk categories: Diseased and Diagnosed, Diseased but Undiagnosed, At-risk and Healthy. Once members are properly categorized, they can be presented to Medical Management for evaluation, comment and action.
By structuring a comprehensive plan to monitor and enhance Medical Management engagement, you’ll see improved diagnosis rates, patient education, patient compliance and overall wellness. And that’s good for everyone.