Disease
Management: Disease management has the twin goals of
cost savings and improved participant health. Our program utilizes
claims data, pharmacy data and assessment information. There
are four steps in the medical management cycle:
 |
Predict |
|
Identify |
|
Manage |
|
Measure |
Early Case Identification
We have invested in a sophisticated neural net to analyze
past claim and pharmacy data to identify each member's risk
of incurring substantial claims in the future. This process
allows us to identify with high probability those members
that are likely to incur $20,000 or more in claims in the
next twelve months.
Identify Actual Disease and Risk Factor
Status
Our leading edge tools involving extensive clinical algorithms
identify the disease state profile of the group by individual
member, based on claims data and pharmacy data. Our identification
program identifies from the data where care deviates from
accepted best treatment practices. Exceptions failures of
care can be referred to case management.
Manage Risk Factors and Disease States
Our outstanding clinical nursing staff intervenes both with
patients and providers to facilitate best practices. Chronic
conditions are managed in coordination with the patient's
providers to help assure quality of care. Treatment practices
and life style issues are addressed with the intent of improving
health and reducing cost.
Measure Results
A program is only as good as the measurable results it achieves.
Results are measured both clinically and financially. The
cost of the disease management interventions including managing
chronic illnesses has significant financial benefit for employer
groups. Our data warehousing capabilities capture claims and
pharmacy data as well as integrating the clinical and management
results from our disease management interventions. From the
data the ongoing health and risk factors can be determined.
The effect of interventions both clinically and financially
can be determined. The episodes and severity of risk factors
and disease states are also measured. Outcomes, financial
and clinical are determined. Evidenced based decisions can
be made about such items as underwriting, provider performance,
future costs and plan design.
Boon-Chapman is committed to the concept that the best way
to reduce cost is to improve the health of group members by
managing risk factors and chronic illnesses and reducing failures
of care. |
