High-risk Disease Management

 

Makes an impact on the highest risk members of a population

Club Health High-risk Disease Management combines predictive modeling, education, monitoring and lifestyle coaching to identify and manage the members most likely to incur the greatest health care costs in the future.  The goal is to reduce or prevent the escalation of health care costs. 

 

Fast Facts

• High-risk Disease Management is accredited by URAC.
• Cutting-edge predictive modeling software identifies future high-dollar members using claims, pharmacy and other data.
• Cases can be referred to the program by providers, Utilization Management, Case Management, Care Line (24/7 Demand Management) or employers.
• Clinical assessments ensure interventions based on specific member needs. 
• Members have access to around-the-clock nursing support via American Health’s toll-free Care Line.
• Members receive outbound calls based on level of severity.
• All members receive welcome packets and educational material appropriate to their condition and intervention level. 
• Satisfaction surveys are sent to members annually and upon case closure.
• American Health’s nurses communicate with members’ primary care physicians as appropriate regarding members’ program involvement.
• Our nurses work with members to help them understand their risk factors and utilize the most appropriate resources in the most appropriate settings.
• Clients receive reports outlining progress of the program.
• Club Health’s programs are compliant with HIPAA privacy regulations.
• Satisfaction surveys are sent to members after 9 months and/or at disenrollment.