Payers and providers must be more focused on outcomes than ever, particularly with the shift to value-based models.
But few, if any, stakeholders have all the data and influence necessary. Health insurers, providers and community resources all have their own relationships with the member, patient and consumer, but rarely do the three come together with the patient’s well-being prioritized as a unifying mission. At the same time, lowering healthcare costs is a nationwide challenge and one that health plans grapple with every day. A small number of the highest risk members are responsible for the great majority of healthcare costs. Identifying, reaching and engaging with those members is critical for improved outcomes and lower costs. Many stakeholders must be part of an ecosystem that surrounds the member, monitoring, engaging and providing key services in all settings. This is a new way of providing healthcare and one that demands a new kind of care coordination solution.
HealthRules CareManager offers a complete 360° view of the member that allows internal and external multi-disciplinary care teams to share responsibility for coordinating member engagement across all types of programs. Care managers, providers and community resources, sharing common insights, can work together, providing true care coordination.
Insurers, providers and community resources all have their own relationships with members, patients and consumers, but rarely do the three collaborate with a unifying mission. This eBook explores real-world examples of care collaboration success between insurers, providers and community resources that have a positive impact on health outcomes.
HealthRules CareManager allows health plans to lower healthcare costs by providing capabilities for managing members and populations in the most efficient way, resulting in optimized quality metrics and higher reimbursements.
This includes identifying members for inclusion in/exclusion from care management programs, generating care plans or follow-up medical events and recommending interventions for members in high-risk or specialty care programs.
Health insurers implementing the HealthRules CareManager solution proactively reach out to patients to improve engagement, launch effective care coordination initiatives resulting in a happier and healthier member population, increase quality measures and reduce clinical and administrative costs.
WEA Trust is a not-for-profit health plan in Wisconsin that serves public employees and their families. This case study details how WEA Trust uses HealthRules CareManager to perform care management, disease management and utilization management to transform its traditional case management methodology into a comprehensive, market-leading and customer-centric approach.
HealthEdge provides the only modern, enterprise class software platform for health plans. HealthRules is a Software as a Service (SaaS) solution, which means lower costs, and faster implementations and upgrades for HealthEdge customers. Regular software updates deliver valuable new capabilities, allowing health plans to stay current and competitive with the latest market developments, while drastically reducing both IT and operational costs. Our technology infrastructure and industry expertise enable HealthEdge to provide our customers with an ongoing competitive advantage, staying in front of market changes, whether they are of a regulatory or business nature