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There are 40 item(s) tagged with the keyword "Health Plan".

Displaying: 1 - 10 of 40

Ongoing Education on Alternate Sites of Care Can Reduce Inappropriate ER Utilization

With higher and higher ER bills coming in to the plan and members, employers are learning that it’s more important than ever for them to make sure that continual reminders are sent to their employees and members about which conditions can be handled by more convenient and lower cost sites of care such as a nurse advice line, telehealth (which often also covers behavioral health), on-site or retail clinic or urgent care. They’re also sharing details on how to reach these resources, and how much lower out-of-pocket costs will be to members who utilize them versus the ER. Keeping this information top of mind when it’s needed is the key to effective communications in this area.

Tags: ER Utilization, Health Plan, Employers, Telehealth, ER Bills, Urgent Care, Non-Emergent Care, Emergency Room, Utilization
Keys to Truly Impactful and Measurable Employer Health & Wellness Programs

With medical costs rising, pharmaceutical costs quickly meeting or exceeding medical costs and miraculous specialty drugs coming in at nosebleed costs, optimizing employee health and saving for catastrophic events is paramount to afford expensive lifesaving medicines and treatments, along with inevitable catastrophic cases that plague nearly every employer’s health plan.

Tags: Health Plan, Healthcare Costs, Wellness Program, Pharmaceutical Costs, Medical Costs, Brokers, TPAs, Health Insurers, Chronic Conditions, Benefit Design, Care Gaps, Population Health, Predictive Analytics, predictive modeling
Pre-Emptive and Analytics-Based Early Action Can Delay Kidney Dialysis, Reduce Plan Costs and Improve Quality of Life

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health & Joy McGee-Cory - Senior Vice President, Advanced Plan for Health

Early intervention is the key to slowing or stopping chronic kidney disease (CKD), improving the quality of lives for those at risk and containing health plan costs. Avoiding dialysis for just one member represents a health plan savings of $350,000 to $700,00 per year, which more than pays for the CKD program by itself.

Tags: Kidney Dialysis, Predictive Analytics, Healthcare Costs, Care Management, Health Plan, Kidney Disease, Poindexter, Diabetes, High Blood Pressure
What more do employer groups expect from their health plan or TPA?

In this busy selling season for TPAs and health plans, we wanted to share an updated eBook that outlines some of what the Advanced Plan for Health is hearing from our TPA, health plan and employer clients related to what employers are really looking for as they’re shopping for benefits.

Here’s an excerpt:

Providing your employer clients with the right mix of services and support boosts your chances of standing out and winning and retaining their business. Fortunately, most self-insured employers want the same thing: healthy employees, positive employee healthcare experiences and reduced costs. Sounds simple enough, but how can you be sure that you are offering the best solutions in today’s strained and ever-changing healthcare environment so that you can continue to differentiate yourself and show value?

Tags: Health Plan, TPA, Third Party Administrators, Employers, eBook, Advanced Plan for Health, Employee Benefits, Employee Benefits
Taking the final mile with Population Health data findings - Nurse Navigation is one avenue

More and more frequently, our current and prospective employer group clients will ask us what we see as the most effective avenues to support employees and members who have been identified through analytics for outreach and support.

There are many avenues that our clients are taking to get individuals the education and support they need. Nurse Navigation is one of the most effective programs that we’re partnering with our clients to launch and manage. We thought this would be a good topic to cover during National Nurses Week.

Tags: Nurse, ER Utilization, Gaps in Care, Employers, Health Plan, Chronic Conditions, Analytics, Poindexter, Health, Nurse Navigators, Population Health Analytics, Population Health Management, RN, Predictive Analytics, Healthcare Analytics, Healthcare, Healthcare Informatics
Unexpected Unreasonable Claims Costs in Intraoperative Neurologic Monitoring (IONM)

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health & Joy McGee-Cory - Senior Vice President, Advanced Plan for Health

Several of our Health Plan clients and their members have experienced unexpected and very unpleasant surprises following certain complex surgical procedures – usually spine-related. So we wanted to get a cautionary word out a bit more broadly on this topic to our clients and others who may be facing similar situations. The surprises are coming in the way of bills for intraoperative neurologic monitoring (IONM).

In one case, the billing technician was not a physician, and the member’s bill for monitoring services was an unreasonable, non-negotiable $120,000.

Tags: Health Plan, Surgical Procedures, Healthcare Risks, Intraoperative Neurologic Monitoring, IONM, Out-Of-Network, Top Procedures, Medicare, Utilization
Imagine getting eight engagement calls from your health plan in one week...

Engaging and educating healthcare consumers on plan benefits, cost-saving options, health risks, as well as the benefits of closing gaps in care can spur action and the desired results. But disconnected messaging via multiple outreaches can cause aggravation and discontent. Even leading to member attrition.

Tags: Health Plan, Support Program, Members, High Blood Pressure, Prescription, Flu Shot, Carrier, Educate, Healthcare Consumers, Plan Benefits, Cost Savings, Health Risk, Benefits, Gaps in Care, Member Abrasion, Outreach Strategies, Analytics, Longitudinal Analytics, Comprehensive Analytics, Identify Target Groups, Advanced Plan for Health, Member Population Costs, Medical Claims, Pharmacy Claims, Lab Biometrics, EMR data, HRAs, Analytics Platform, Poindexter, Track Results, Measure Program Success, Member Engagement
Combating Opioid Addiction with Analytics and Case Management

The current opioid epidemic has shed light on the shortcomings of many wellness programs and the lack of preparedness by case management teams to handle chronic conditions and or patient behavior, such as addictive tendencies or duplicate therapy. But are case management teams solely to blame for lack of effective response to this costly health crisis? The simple answer is, no.

Many case managers do not have access to the data or tools required to employ a compelling and value-driven prevention model. Hence, what we see today is very little accountability or effective case management. What’s needed most is quality data to guide active engagement with patients.

Tags: Opioid, Addiction, Data, Big Data, Predictive Analytics, Account Management, Health Plan, Insurers, Healthcare, Brokers, Payers, Third Party Administrators, TPA, Epidemic, Case Management, Care Management, Care Manager, Wellness Program, Group Benefits, High Cost Claimants, Costs, Chronic Conditions, Behavior, Duplicate Therapy, Rx, Patients, Advanced Plan for Health, Actionable Insight, Health Intelligence, Poindexter, Self-Insured, Health Plan Sponsors, Catastrophic Medical Events, Drug Costs, ER Utilization
Targeting Doctor Shopping, Prescription Abuse With Analytics: Population Health Lessons from the Front Lines

In recent years insurers and brokers have had to adapt to rising healthcare costs without much say in the matter. This is in part because brokers and employee benefit managers often have too much on their plates to sleuth out and address the costliest “blind spots” in health coverage. This has left many struggling to find a way to remain competitive in an increasingly technology-driven industry.

Tags: Doctor Shopping, Prescription Abuse, Population Health, Healthcare, Data, Data Analysis, Health Insurers, Benefits Design, Population Health Management, Member Population, PHM, Health Events, Cut Costs, Health Events, Prevention, Brokers, Employee Benefit Managers, Health Insurance Brokers, Predictive Analytics, Actionable Insight, Health Plan, Health Plan Member, Doctors, Duplicate Therapy, Poindexter, Predictive Modeling, Healthcare Costs, Self-Insured, Employer, Pharmacy, Rx, Data Analytics, RFP, Network, Data Reports, Lab Costs, Technology, Chronic Pain, High Cost Claimants, Addiction, Opioid, Cost Centers, Behavior, Behavioral Analytics, Phenotyping
Competitive Advantages That Every Health Insurance Broker Should Know

The webinar included Business Insurance, Advanced Plan for Health, Turner Industries and BancorpSouth Insurance Services, Inc. and offered insights on how to leverage advanced analytics throughout the year at various points in the annual sales and service cycle. It also outlined real-world case studies of health data analytics in practice, resulting ROI and the many benefits analytics has on health plan performance and the competitive advantages it can provide brokers looking to set themselves apart from the crowd.

Tags: Webinar, Business Insurance, Health Plan, Advanced Plan for Health, APH, Population Health Management, Predictive Analytics, Health Insurance Broker, Health Insurance, Predictive Analytics, Health Data, Interoperability, Business Tool, Predict Risk, Predictive Modeling, Healthcare Costs, Self-Funded, Stop-Loss, Self-Insurance, Gaps in Care, Gaps in Care

Displaying: 1 - 10 of 40