Asset 1 Asset 1 Asset 1 Asset 1 Asset 1 Asset 1 Asset 1 Asset 1 Asset 1
mobile-ornament mobile-ornament mobile-ornament mobile-ornament mobile-ornament mobile-ornament mobile-ornament mobile-ornament mobile-ornament
Asset 2 Asset 2 Asset 2 Asset 2 Asset 2 Asset 2 Asset 2 Asset 2 Asset 2
Asset 3 Asset 3 Asset 3 Asset 3 Asset 3 Asset 3 Asset 3 Asset 3 Asset 3

Improving the health of your employees and health plan, while positively impacting clinical and financial outcomes, is critical to getting the best benefit. This blog explains how to do it.To ensure cost-effective, quality health care, you need to control and manage your health plan like you do your core business. That means making sure that clinical and wellness initiatives are working as intended, and integrated among the member, insurer, plan and the provider team.

Population Health Management (PHM) is the continuum of care from wellness to catastrophic conditions across all treatment settings. A successful PHM plan in large part depends on the help of a local Nurse Care Navigator (NCN) and their ability: (1) to address the causative factors driving health behavior and lifestyles, (2) to arm them with education and support, and (3) to network proactively with local providers, the insurer and community resource; thereby avoiding expensive emergent and inpatient occurrences. A well trained NCN will delve deep to better understand the problem, work with targeted members and providers, and then monitor interventions both at the macro and micro levels to be sure that they are working. In addition, they will be trained and experienced enough to ask—and help answer—wide-ranging rhetorical questions meant to improve plan efficiency: 

  • Do you have adequate data transparency and input in evaluating wise resource allocation, utilization, and impacting decision on intervention
  • How do vendor savings align with the plan metrics and the checks written by your CFO from your self-insured account
  • Who sought care out-of-network during a user-defined timeframe
  • Who had 3 emergency room visits in the past three months 

The end results of posing, and answering the right questions are credible and measurable “bottom-line” metrics that match the Health Plan medical and pharmacy claims reports. Unfortunately, even the most savvy of NCNs are limited by their resources. Employers need state-of-the-art intelligent data systems (Poindexter) to optimize the overall health and well-being of their workforce and families across the health continuum. This intelligent data system receives medical and pharmacy claims reports, and may also integrate biometric data, laboratory results and even health risk assessments. Quality processes and measurements, which enable employers to analyze and improve costs in their core business down to a fraction of a penny, are instrumental in optimizing health plan clinical and financial outcomes. 


More Articles

  1. Wall Street Journal Webinar Review: The Future of Health

    The Wall Street Journal (WSJ) recently provided its audience with a wide-ranging webinar discussion that covered the nation’s ability to address unprecedented Covid19 challenges like proper testing and tracking, social distancing limitations, and a dangerous societal decline in mental health. The WSJ…

    Read More »
  2. The 2020 American Drug Shortage

    In the soon to be 244 years of Independence, the United States of America has been tested beyond measure on countless occasions, and each time Americans have risen to the occasion. Now, America is facing a monumental challenge yet again in a…

    Read More »
  3. APH in the News: Population Health Strategies

    Advanced Plan for Health founder and CEO, Neil Godbey, recently sat down with Benefits Advisors’ reporter, Matt Skoufalos to discuss the state of population health in relation to data management and care management performance. The following is a recap of the interview…

    Read More »
  4. Nurse Care Navigators’ Value to the Self-Insured Health Plan

    Advanced Plan for Health (APH) recently published a blog briefly illustrating the value of nurse care navigators. Nurse care navigators provide self-funded employers with informed health plan management action items devised to improve health plan functionality. Most importantly, however, care management provides employees the…

    Read More »
  5. Combating Opioid Addiction with Analytics and Case Management

    High cost claimants are most responsible for rising health plan costs, but high cost claimants who are addicted to opioids might cripple a health plan altogether Prevention. Prevention. Prevention. When it comes to implementing a health plan case management or wellness program, prevention…

    Read More »

for more?

Check out our Resource Center for
infographics, white papers, and more.



We’re ready to get started! Contact us to see
what APH can do for you and your business.