Health Plans

  • Preventative health & anticipatory guidance (more information)
    • notifies physicians as to which preventative care & anticipatory guidance items are due at time of visit
    • search patient population for patients due for preventative care & anticipatory guidance
    • data can be electronically sent to the health plan on a monthly (or other) basis to avoid delays in accumulating data through claims
  • Disease management (more information)
    • performed at point of contact with patient, thereby reducing expensive outsourcing

  • Regulatory reporting (more information)
    • report communicable diseases to departments of health
    • report immunizations to state or local registries
    • search patient population for patients who require immunizations

  • Decreases cost of pharmaceuticals (more information)
    • control costs at point of contact using formularies

  • Decreases lab/diagnostic costs by speeding the exchange of data and avoiding duplication
Prev. Care & Antic. Guidance window


Disease Mgmt window
  • Enables Health Plans to monitor and institute Pay for Performance (as shown above) by virtue of:
    • search engines
    • immunization tracking
    • anticipatory guidance
    • compliance with national standards of care
  • All the above enables Health Plans to exceeds state averages for indicators of quality of care and HEDIS, thereby making the Health Plan more competitive in acquiring covered-lives

  • Summary of Benefits