Health Risk Management (HRM) Services

1. Analyze Existing Health Risk Management (HRM) Components of the Health Plan.
2. Capture and Analyze Healthcare Data from all Available Sources, including:
   • Medical Claims,
   • Prescriptions Drug Claims,
   • Member Demographics,
   • Health Risk Appraisals / Assessments,
   • Member Interviews,
   • Utilization / Disease / Case Management Reporting,
   • Lab Values,
   • Employee Assistance Plan (EAP) Reporting, and
   • Output from Analytical Tools (e.g. Prescription Utilization Analysis, Predictive Modeling Software, etc).
3. Identify and Stratify At-Risk Members Based on Propensity for Future Care Costs and Anticipated Response to Medical Management.
4. Construct a Comprehensive Health Risk Management (HRM) Strategy.
5. Introduce Member Health Status Improvement Programs.
6. Develop a Health Awareness Activities Calendar.
7. Provide Periodic Educational Materials in the form of Posters, Payroll Stuffers, Handouts, etc.
8. Select Medical Management Firm and Data Analysis Tools.
9. Integrate Utilization, Disease and Case Management Programs within a comprehensive HRM Program.
10. Manage the HRM Program to:
    • Identify At-risk Members and Target Them for Intervention,
    • Deliver to the Medical Manager Targeted Members where Intervention should be Explored,
    • Determine if Medical Manager has Already Been in Contact with Identified Members,
    • Ensure that Medical Manager Reaches Out to Identified Members with Education and Support,
    • Track the Intervention and Quantify the Outcome of the Intervention from a Qualitative Perspective, and
    • Provide Plan Sponsor with Reporting and Interpretation of Medical Management Reports.