Utilization Coaching

PlanWell automatically scans gaps in care and provides coaching report card to healthplan members.

Understanding and navigating the U.S. health system can be very complicated and ultimately leaves many of your healthplan members confused on what care and providers to access. PlanWell Health utilization coaching helps simplify things.

We begin by leveraging your plan claim data analytics through our integration with Self Insured Reporting, accessing all of your members health plan claim data and metrics. Next we scan for opportunities of improvement and personalize these insights on behalf of each plan member.

We then deliver a monthly coaching report to each member showing simple ways they can take different actions and achieve better health outcomes.

Prevention Gaps in Care

Tracking needed preventive health procedures on an automated basis from health plan claims data.

The U.S. Preventive Services Task Force is a panel of national experts in disease prevention and evidence-based medicine.  For each demographic group there are specific recommendations regarding preventive health that should be followed in order to maintain optimal health.

PlanWell Health puts these recommendations  ‘front and center’ for each app user.  The PlanWell app integrates with personal health profiles created inside Self Insured Reporting.  We then make this data easily accessible by your plan members so that they are made aware of any missing recommendations regarding their preventive health practices.

Missing Prescriptions

If you are missing a prescription that is often used to manage a chronic condition, we will alert you.

A missing prescription, or gap in pharmacy care, exists when there is a discrepancy between the medications that are taken by a patient and the ones they should be taking based upon guidelines for their health conditions.  An example would be when a patient with high cholesterol is not taking any medication for that condition.

Of course we cannot know when one of your healthplan member takes a medication, but we can know if they have filled a medication.  PlanWell Health automatically scans each of your healthplan members medical claims profile to see if they have a chronic condition.  Next, we scan each person prescription drug history to determine if a drug is being regularly filled in the treatment of that condition. 

Chronic Gaps In Care

Track your progress towards managing chronic conditions and see how your health risk changes over time.

Although we know the essential elements of caring for those with chronic conditions, there often persists a gap between what is recommended and what actions are taken.  For employers maintaining a healthplan this is of double concern not only for the health and productivity of their employees, but also for the financial health of their self-insured group medical plan.

PlanWell Health identifies existing gaps in care automatically based upon filed claim patterns of your enrolled healthplan members.  We then make these gaps highly visible to your plan members, helping them stay aware of any gaps.  Finally, we create risk scores for each member which change over time based upon their compliance with recommended protocols.