HealthComp utilizes medical and pharmacy claims data management software, coupled with a Physician Risk Analyst, Registered Nurses, and Clinical Pharmacologists to evaluate our clients' medical risks. We then develop proactive strategies to reduce these risks, resulting in a total approach to Plan management.
Once the medical risks have been determined, the Wellness Management Team assesses the targeted population, provides specialized interventions unique to each client, follows up on those interventions, and finally offers customized reporting for “return on investment.”
Wellness Management is a systematic, goal-oriented, and behavior-driven program providing interventions through telephonic nursing support. The intent is to help patients better understand their role in making informed choices about their own health.
Health education and decreasing long-term complications via an outcome-based approach is the goal. The basic philosophy is that “people who are in good health are happier, more productive and incur less in healthcare costs.”
HealthComp's Wellness Management Program is a specialized program encompassing three key areas: Disease Management, Preventative Care, and Pharmacy Management.
This is a focused approach to chronically-ill patients who have potential for treatment or lifestyle modifications, which may improve their outcomes and/or reduce healthcare expenditures. The Program targets the following chronic illnesses: Asthma, COPD, Diabetes, Cardiac conditions, High Blood Pressure, and High Cholesterol.
The nurse or doctor develops a customized plan to assist these patients in achieving beneficial outcomes. Interventions may include providing patient and family education, pharmacy reviews, telephone contacts with the patient's healthcare providers, referrals to specialists, obtaining medical supplies, and providing community resources or support group information. The Wellness Management staff also offers emotional support and encouragement to all patients and provides them with tools to take control of their healthcare issues.
Through our data-management tools, HealthComp identifies those members who have not had their recommended preventative screening exams, based on national guidelines. The Wellness Management team provides personalized reminders asking members to utilize prevention benefits for their age-appropriate cancer screenings, physical exams, immunizations, and well-baby check-ups. General assessments for patients who don't have a specific illness are also available to determine areas that can be improved upon in order to “prevent” future health issues.
Because of skyrocketing costs, medications comprise a substantial portion of the healthcare dollars spent each year. Pharmacy Management is a critical component of the Wellness Management program, providing an analysis of patient-drug utilization, based on paid claims data for a specific period.
Data is retrieved by HealthComp through online access to the Pharmacy Benefit Manager’s database and through our specialized data management program, which correlates this data with the medical claims.
The data retrieved:
- Identifies deficits in care.
- Identifies drug-use trends.
- Identifies potential stop-loss claimants.
- Identifies retail versus mail-order option.
- Identifies those using brand-name drugs rather than available generics.
- Identifies potential fraud.
Where applicable, Licensed Pharmacologists provide individual member reviews based on referrals from HealthComp’s Wellness Management team. The Pharmacologists are available to make clinical determinations regarding appropriateness of medications prescribed, drug-to-drug interactions, available generic or more cost-effective medications, and possible fraud issues. As clinicians providing patient care, they also contact both members and their medical providers to discuss their findings or recommendations.