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Is Your Health Plan on Auto Pilot?

If your health plan is giving you ho-hum results you can do better!

Symptoms of Health Plans on Autopilot (Check all that apply)

_____ You spend your time watching medical and drug costs go up and feeling helpless

_____ Some emergency room visits and inpatient admits could be avoided

_____ The slick, canned quarterly report is not dynamic and immediately responsive to your questions or desire to drill down to the causative factors

_____ You want to know how reported “savings” impact your bottom line

_____ You need a strategy to encourage employees to better care for themselves

_____ You would like to drill down to see how you can cut waste and change trends

_____ It takes dynamic information to make decisions, track operations and achieve desired outcomes. You have it for your business to the nth degree, but not for your Health Plan

_____ I am missing “the local advantage” where a professional care manager helps us access our community resources and health providers, and provides personalized guidance through the complex health system to needed support and care

_____ I need help in saving more to pay for the inevitable catastrophic case.

Most health plans have a stable of products that cover the basics, but may not include the “extras” that you’ll need, when confronting chronic health conditions or unanticipated events. We all know that life often throws us a curve ball. 

Life can change suddenly. One day you are doing fine, and the next day your whole world is turned upside down by a major illness. That is when little things, like a “personal touch” and professional help in navigating the healthcare maze takes on a whole new meaning. Experiencing major health events can be a game changer. Let’s walk through some common situations and solutions health plans may face.

Scenario 1

Mary has serious chronic health conditions, just lost everything in the hurricane, and needs help in finding community and health resources to get her through this catastrophic event.

Scenario 2

Henry has diabetes, but does not have the money for co-pays, because he must make choices between buying groceries and filling his insulin and blood pressure prescriptions.

Scenario 3

Sam weighs 400 pounds and wants knee surgery, which should be deferred until he can lose some weight, to avoid complications like, post-operative joint instability and non-healing of the surgical wound.

Scenario 4

Mike is confined to bed and was just discharged from the hospital to his home, but everyone in the household works and he will be alone for 8 to 10 hours each day.  Avoiding a readmission or disaster means leaving him with self-care options, water and food— Has anyone thought this through?

“Who are the individuals on your Health Plan who have a high probability of having a myocardial infarct (heart attack) in the next 12 months?”

These are the practical issues and typical scenarios that confront self-insured companies and health plans daily. But take a deep breath, you are not powerless. You can improve your health plan performance simply by having access to the right analytic search engine. For example, Advanced Plan for Health’s Poindexter condition-specific modeling platform pushes the boundaries of predictive analytics by determining the likelihood of an occurrence of coronary events, neurological events, orthopedic events and chronic kidney disease.

With Poindexter, you’ll be better prepared to find proactive ways to improve the health of your workforce, contain costs and provide personalized, supportive services to plan members who need help. You can do this! It is time to take charge.

The first step is to have a dynamic, analytic search engine that allows you to better understand your plan trends and opportunities. The tool needs to be easy to use, and should allow you to take a deep dive to get answers and reports with a couple of computer clicks, providing you with a baseline on which to build your implementation plan and strategies and a method to assess the progress you are making. The focus needs to be on action, outcomes and member experience, rather than on “process”. Let the data be your guide.


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