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HealthReach Predictive Care Management®

  • Proactively identifies emerging risk by analyzing consumer health data to provide comprehensive, personalized care management services
  • Consists of at least eight different interventions, including enhanced physician support, virtual nursing, and data monitoring on improved health and risk
  • Predictive modeling with AI stratifies patient populations by risk and IDs gaps in care and opportunities for intervention

We personalize multiple health strategies into one integrated suite of products to enhance individuals’ health journey and impact outcomes.

Cost reduction for a HealthReach graduate:

in year 1
over 6-year period
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Consumer health platform

  • Dashboard reporting of risk analytics
  • AI to identify individuals needing actionable follow up
  • NavPro system to track, manage, and report
  • Member engagement based on data and personalization

Care gap management

  • Integration with PCP care plan
  • Explanation of labs and care gap closure visits
  • Monthly outreach and targeted mailings

Medication management

  • Drug interactions
  • Duplicative therapy

Plan coordination & navigation

  • Plan design support from reference-based pricing to narrow or high-performance provider networks
  • Promote coordination with other member initiatives care (telemedicine, onsite or near site clinic, EAP, diabetes supplies)
  • Coordination with wellness and plan carve outs

Primary care support

  • Communication with PCP of nurse interaction outside the clinical visit
  • PCP care plan support with patient focus
  • Explanation of lab results and impact to health

Lifestyle coaching

  • Opt-in coaching program
  • Healthy eating
  • Weight loss
  • Fitness
  • Stress management
  • Tobacco cessation

Care management

  • Nurse follow up with communication and patient education
  • Management of health assessments
  • Coordination with medical management services and SDOH

Personal portal

  • Personal online health record
  • Tracking of medical and prescription claims, doctors’ appointments, reminders, and upcoming screenings and tests

Virtual Nursing and Outreach Programs

  • Individual programs unbundled with specific focus customized and based on client need and potential immediate impact
  • Secure and HIPAA compliant text, email, and calls based on client need
  • Targeted campaigns based on HCS Health Platform or client’s existing population health analytics to create highest value of impact

Technology and virtual nursing allow for each program to be tracked with reporting on utilization and outcomes (cost and clinical) regardless of program or design.

Key results:

INCREASE in care gap closure
INCREASE in pharmacy interactions closure
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Medical Management Services

  • Comprehensive management of catastrophic injuries, illnesses, and chronic care needs
  • Thorough reviews by case managers of referred individuals to formulate a mutually beneficial management plan that ensures the patient and family are completely supported in the decision-making process
  • Online real-time reporting capabilities to communicate with the health plan regarding case activity and coordination of care

Large case management covers multiple specialties, including medical, surgical, mental and behavioral health, chemical dependency, and high-risk maternity.

HCS has delivered an ROI of 5:1.

Utilization management

URAC accredited utilization review program that determines medical appropriateness of treatment, procedure, admission, level of care, setting, and length of stay, and assesses discharge needs

  • Includes inpatient and outpatient services
  • Admits/1000 are 15% below national averages year over year
  • Days/1000 are 20% below national averages year over year
  • Precertification services

Large case management

Comprehensive management of catastrophic injury and chronic care needs

  • Potential cases are triggered through UM program that has 5:1 ROI for the book of business
  • Large case management covers multiple specialties including:
    • Medical and surgical
    • Behavioral health including chemical dependency and high-risk maternity
  • Through online real-time reporting capabilities, communicate with health plan regarding case activity and coordination of care

Independent review management

  • Management and coordination of independent reviews
  • Partnered with URAC accredited independent review organizations
URAC Accreditation Seal
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