Uses predictive modeling to aid in patient identification and management.
Disease Management combines
predictive modeling with education, monitoring and lifestyle coaching to
identify and manage the members most likely to incur the greatest health care
costs in the future. The goal is to reduce or prevent the escalation of
health care costs.
Key Features and Advantages
- Cutting-edge predictive modeling software identifies future high-dollar members using
claims, pharmacy and other data.
- Cases can be referred to Beyond Disease Management program by providers, Utilization
Management, Case Management, Care Line (24/7 Demand Management) or employers.
- Clinical assessments ensure proper member risk stratification.
- Members have access to around-the-clock nursing support via a toll-free
- Members receive outbound calls based on level of severity.
- All members receive welcome packets and educational material appropriate to their
condition and risk level. Satisfaction surveys are sent to members annually and
upon case closure.
- Nurses communicate with membersí primary care physicians to coordinate care plans and
- Our nurses work with members to help them understand their risk factors and utilize
the most appropriate resources in the most appropriate settings.
- Clients receive quarterly
and annual reports outlining progress of the program.
- The Beyond Disease Management program is compliant with HIPAA privacy regulations.