Risk Assessment and Stratification
Our proprietary risk reduction process begins by identifying current and potential high risk members within your group. This is typically performed through a health risk assessment (download sample) distributed to all adult members on the health plan (or only adult employee members, as the client desires). If the employer has access to more robust claims information systems, we would request to have access to this information also.
Once these risk assessments have been returned, our medical staff will begin their review to identify the high risk members whom will be targeted for ongoing monthly meetings. The typical employer will have 90% of the employees considered ‘under control’ after this risk assessment, and nothing will be required further of them for the given calendar year.
The remaining population of approximately 10% will be contacted and encouraged to participate with our nursing staff in the disease management program. Each individual employer can make their own determination regarding incentives they would wish to deliver to employees for their participation, such as reduced copays for certain drugs or other financial incentives.
One-on-One Meetings with High Risk Members
Once the high risk members have been identified, ongoing monthly meetings will begin based upon the disease management selected by the employer. During these meetings, each member will be given an actionable plan to help them become compliant with the evidence based medical norms for their particular conditions.
As an example, a medical plan participant with diabetes would have the following standard of care:
- 3 primary care office visits per year
- 2 to 4 hemoglobin A1C test per year
- Controlled blood pressure if normal is in excess of 140/90
- Lipid profile controlled
- 1 dilated eye exam per year
- 1 urine screening per year
|The program implementation involves a nurse to meet one-on-one with each identified high risk member the medical plan, typically 10% of the total adult members. The specific goal of these ongoing meetings is to build relationships and work with the plan participant to help them become compliant with the prescribed overall medical standard for their condition.|