Employers /
Insurers / Healthplans
A recent study found that the majority of
employers offering disease management programs
have less than a 15% participation rate among
eligible patients. Assessment of one large
employer’s program found that only 50% of
enrolled members interacted with a clinician two
or more times during the program.
Employers, risk bearing payers, and insurer's all
have a keen interest in reducing the escalating
cost of chronic conditions, now estimated at 75%
of our $2 trillion health care budget in the US.
Yet recent studies have shown that many disease
management companies are not returning the ROI
needed to sustain their rising costs.
OutcomeAdvantage offers automated processes and
tools that can provide better monitoring and
engagement to aid in the management of chronic
disease while reducing costs.
Disease management programs are designed to
coordinate interventions, reminders, and self-care
solutions. When patients are fully engaged,
they’re more likely to take positive corrective
actions. A key barrier to the effectiveness of
disease management programs is how information
flows from payers to providers and patients.
OutcomeAdvantage has the tools to improve
communications flows from the patient to provider:
- Intelligent patient/provider communications
for automating a number of manual tasks
including Health Risk Assessments, baseline
data, risk stratification, enrollment
- Interactive, disease or condition-based
scripts queries the patient for compliance and
education needs
- Scripted Education for the patients will
empower them to learn more and become engage
in their health needs
- Trending and analytics can track patient
responses and allows opportunity for triage
and earlier intervention
- Automated system is scalable, adaptable to
many conditions
Our Care Management Platform is ideally suited for
monitoring and intervention for "at risk" patients
and can include patient education, adherence to
care plans, logging of care plan metrics, and
preliminary screening for those clients at risk
for acute events. The system can act as an
outbound triage program for DM patients to provide
an altered course of care strategy such as a
change in medications, PCP or specialist
consultation ahead of a previous planned office
visit.
Reduced Hospital Readmission:
One of the highest preventable costs from disease
management is reducing hospital readmissions. From
hospital discharge to first appointment with a
doctor (or between visits to the doctor) patients
frequently experience exacerbations of their
conditions, yet often fail to report them. In such
cases, the disease can progress to the point where
hospital readmission is necessary. Our Care
Management Platform keeps in touch with these
patients —monitoring important changes in their
symptoms— and notifies providers when signs of
trouble appear, before their condition becomes
critical. Improved patient monitoring will lead to
better outcomes, at lower cost, with substantial
reduction in the rate of hospital admission.
A Shift in Priorities - Episodes of Care and
Pay for Performance
Employers are at the top of the food chain and can
have a strong influence on shifting priorities
from being reactive to proactive. As healthcare
priorities change to wellness, illness avoidance
and avoiding admissions, we will see a shift
toward providing incentives to direct the
healthcare dollar to the provider who provides the
best outcomes. OutcomeAdvantage can provide access
to actionable information throughout the entire
range of the episode of care, can facilitate
operational efficiencies, best practice
approaches, reimbursement based on quality of
outcomes as opposed to number of patient visits,
and overall reduction of healthcare delivery costs
below the episodic payment level. Today, the tools
are missing to assure an effective continuum of
care throughout the entire episode of a patient’s
care - our platform fills that gap.
Corporate Wellness Programs:
Insurers have expressed interest in offering more
tailored programs for healthy clients but also
monitoring the walking wounded and high-risk
employees. Individuals with chronic diseases such
as diabetes may experience the highest rate of
positive results in this type of program. People
with diabetes who are educated in the management
of their condition, how to monitor their blood
sugar levels, and to use diet, exercise,
medications, and injections of insulin, will
minimize the impact of diabetes on their health.
In addition, asthma and chronic obstructive
pulmonary disease (COPD) are also
chronic/non-acute conditions that respond to
continuing daily care and management by the
patient.
HEDIS Scores:
The Healthcare Effectiveness Data and Information
Set (HEDIS) scores is the report card for
comparing health care plans across different
performance dimensions. By closely monitoring
patient follow up and protocol compliance, our
Care Management Platform can flag non-compliance
from HEDIS measures early on and send an early
warning or an alert to physicians and patients,
alike, thereby causing higher and better HEDIS
scores. |
|
57%
of those who are
privately insured under the age of 65 have at
least one chronic condition -- AHRQ
|
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