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By Greg Cieslewicz
One of the things that sets apart the WEA Trust health insurance plans is our proactive care management programs. These programs provide intervention opportunities for members before complications or costly events occur.
Our programs complement the care members receive from health care providers. Trust care management programs help members gain a better understanding of their health condition, improve self-management, and become informed decision makers. If members can manage their health care better and adhere to national standards of care, they are more likely to experience positive results.
Our care management programs focus on certain members – those who have a chronic medical condition or are at risk of developing one, and those who are at risk due to compliance gaps with national standards of care. While the Trust has done this for years, we recently implemented a state-of-the-art tool to help us do it better.
Data-driven decision making
This tool is software that processes large amounts of health care data. Based on national clinical standards, it identifies members who could benefit by working with one of our care managers.
The Trust has only been working with the software for 15 months, but it has already allowed our care managers to double the amount of new cases handled each month. By increasing the number of members we accurately identify, we use our members’ health care dollars more wisely.
Better care; less cost
The software identifies which members appear to lack appropriate care for their condition or are receiving inappropriate care. If gaps are identified, Trust care managers will contact members, explain the findings, and ask members to discuss the findings with their doctors.
Early identification of risks means an opportunity to improve care, curtail future risks, and reduce costs. By identifying the right members at the right time, we can help members improve management of complex conditions—leading to improved outcomes and quality of life.
Information on the products and services that Member Benefits offers to public school employees can be found online at www.weabenefits.com.
Posted March 1, 2008