Condition Management Programs

HealthLink’s Condition Management programs take an individual-centered approach to supporting people with greater health needs. Fully licensed health professionals coach individuals to better understand their conditions and develop self-management skills. A component of HealthLink’s Health Care Management system, the Condition Management Programs are available on a PEPM basis.

Drawn upon the experience and best practices within WellPoint, HealthLink’s Condition Management programs effectively identify members with chronic conditions, engaging those members to self-manage their conditions.

AccuStrat® - Proven Predictive Modeling
HealthLink’s Condition Management programs utilize AccuStrat, a predictive data analysis tool that effectively identifies high risk health plan members. The AccuStrat model both identifies members appropriate for disease and case management interventions, and focuses on Medical Management integration. Many companies use models developed for financial and pricing applications, which are effective for actuarial analysis but lack the ability to drive clinical evaluation. AccuStrat merges both statistical and clinical approaches to better identify and stratify those at risk as well as their levels of risk. Additionally, the AccuStrat analytic process is customized to each client’s unique demographic distribution, regional coding practices, clinical conditions and claim patterns. This translates into identification and engagement of the most appropriate individuals at risk and results in more cost effective interventions.

Effective Engagement Strategies
Condition Management engagement specialists serve as first contact with members identified and stratified at high risk. The engagement specialists are dedicated exclusively to the task of explaining the Condition Management programs to members and encouraging them to voluntarily participate. They are supported by telephonic tools that maximize personal contact with the member. This approach has resulted in more than 85% voluntary participation in high risk management.

Comprehensive Educational Outreach
Education is a key element of Condition Management. Each participant receives a disease-specific assessment, and is then designated as either “standard intensity” or “high intensity.” Standard intensity participants receive materials related to their condition such as care guides, self-monitoring charts, resource listings, lifestyle tips and quarterly condition-specific educational newsletters. They also receive periodic reminders for screenings and check-ups and telephone access to a registered nurse 24 hours a day for advice or counseling. Members in the high intensity category receive the same information and resources, and are assigned a nurse advisor who calls as frequently as needed to counsel the patient depending on the severity of the condition.

Effective Clinical Management
The Condition Management programs focus on making sure members and physicians understand the importance of adhering to medical and pharmacy guidelines. Medical and pharmacy claims data is analyzed monthly to identify gaps in care, such as lack of preventive screening or potential drug interactions. Members are alerted to these gaps and encouraged to discuss them with their physicians. The programs include regular telephonic and written communication with the member’s provider, including quarterly reports on the member’s progress.

Enhanced Reports and Quality Control
Clients receive quarterly reports, as well as annual reports detailing information about the Condition Management programs and participants.

Condition Management is part of the HealthLink Health Care Management Programs, an extensive suite of health promotion and wellness information, case management and care coordination services to help physicians help their patients achieve optimal health outcomes.

HealthLink®, Inc., is an Illinois corporation.  HealthLink, Inc. is an organizer of independently contracted provider networks, which it makes available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers.  HealthLink has no control or right of control over the professional, medical judgment of contracted providers, and is not liable for any acts or failures to act, by contracted providers.  HealthLink, Inc. is not an insurance company and has no liability for benefits under benefit plans offered or administered by payors.  HealthLink® is a registered trademark of HealthLink, Inc. and a separately incorporated and capitalized subsidiary of WellPoint, Inc. Any reference in the material to other organizations or companies, including their Internet sites, is not an endorsement or warranty of the services, information or products provided by those organizations or companies. Discount offerings made available by third-party vendors.