Products & Services

Chronic Disease Facts

• One Out of Ten Americans are Affected
• They Account for 70% of Healthcare Dollars
• Almost 50% of People with Chronic Disease are Not Receiving the Medical Care Appropriate for Their Condition

Optimal Health - A Solution Providing

• State of the Art Predictive Modeling Software – MEDai Risk Navigator
• Clinical Disease Management Focused on Compliance with National Standards of Care
• Management of Chronic Disease entities with Highest Potential for Impact

• Individual Health Coaches who are Registered Nurses

Risk Navigator Clinical Predictive Modeling

• Incorporates Claim Pharmacy and Clinical Data
• Includes am Initial Analysis of Two Years Data
• Monthly Data Updates
• Identifies Members:
  • With Chronic Disease
  • With Gaps in Care Guidelines
  • Actual and Forecasted Health Risk
  • Actual and Forecasted Healthcare Costs
• Provides In-depth Analysis of Pharmacy Utilization
• Payer Web Based Report Access

Member Identification & Assessment

• Announcement Letter and Welcome Brochure Distributed to All Plan Members To Encourage Participation and Self-referral
• Risk Navigator Clinical Data Analysis Identifies Members With, and At Risk for Chronic Disease
• RN and Physician Assessment of Identified Members “Gaps” in Care.

Member Engagement

• Welcome Brochure and Personal Letter to All Members Identified with Chronic Disease
• Follow-up Phone Calls to Members with Chronic Disease
• Two Additional Mailings and Phone Calls to Members with Chronic Disease
• Third Mailing Includes Educational Material Keyed to the Members Risk and Compliance Level

Ongoing Management

Member Education Track

• Educational Material Keyed to the Members Risk and Compliance Level
• Web-based Educational Links
• Quarterly Contact and Educational Material Provided to Members
• Availability of an RN Health Coach For Each Coaching Participant

Health Coaching Track

• RN Health Coach Assigned to Each Coaching Participant
• Disease Customized “Compliance Plan” Provided for Participants and their Physician
• Calculate a “Health Score” Based on the Participants Compliance with the Standards of Care for Each Disease
• On-going RN Health Coach Monitoring and Evaluation of Compliance Issues
• RN Health Coach Follow-up Before and After each Participant Healthcare Encounter
• Promotion of Plan Wellness, EAP, Utilization and Care Management Programs
• Patient Satisfaction Surveys

Reporting

DSM Activity by:

• Disease Entity
• Member Status
• Participant Compliance Score