Chronic Condition Management

Overview Facts

  • Management of Conditions with the Highest Potential for Impact
    • Asthma
    • Diabetes – Type 1 and Type 2
    • Heart Health Conditions including; Coronary Artery Disease, Hypertension,
    • High Cholesterol, Stroke, Cerebral Vascular Disease and Congestive Heart Failure
    • Chronic Obstructive Pulmonary Disease
    • Focus on compliance with care standards as well as positive lifestyle changes
  • Engagement of Every At-Risk Member
    • Customized outreach via phone and mail.
    • Standards of Care provided to each at-risk member for their specific condition
  • A “Better Health” Management Track for Each At-Risk Member
    • Registered Nurse Health Coaching provides care assessment, custom compliance plan and member goal setting
    • Education and Awareness track stays in front of members not participating in coaching with quarterly better health information
  • Real Time Integration with Utilization & Care Management
  • Sophisticated Predictive Modeling of All Medical and Rx Claims
  • Data Reports that Demonstrate Results

Program Impact

  • Independent Cohort Study Shows ROI of $3.03 per $1.00 and…
  • Claim Trend that is 42% Below Plans Without Care and Condition Management
  • Diabetes Risk Level 1-4 Cost PMPM Lowered 47%
  • Asthma Risk Level 1-4 Cost PMPM Lowered 40%