Uses predictive modeling to aid in patient identification and management.

Beyond Disease Management combines predictive modeling with 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.

Key Features and Advantages

• Cutting-edge predictive modeling software identifies future high-dollar members using claims, pharmacy and other data.



• Cases can be referred to Beyond Disease Management program by providers, Utilization Management, Case Management, Care Line (24/7 Demand Management) or employers.



• Clinical assessments ensure proper member risk stratification.



• Members have access to around-the-clock nursing support via a 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 risk level. Satisfaction surveys are sent to members annually and upon case closure.



• Nurses communicate with members’ primary care physicians to coordinate care plans and interventions.



• 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 quarterly and annual reports outlining progress of the program.



• The Beyond Disease Management program is compliant with HIPAA privacy regulations.