CHICO, Calif., June 23, 2011 /PRNewswire/ -- Landacorp, a Carewise Health affiliate and leading collaborative care solution provider, presented health plans with a strategy for winning the health exchange opportunity at the World Health Congress held recently in Chicago. Healthcare reform has created the need for health insurance exchanges that sell to individuals without regard to health status and allow for portability, as well as offer a choice of plans, a mechanism for enrollment, and information about plan provisions.
Health insurers have long recognized the risks associated with bringing new members into a health plan, but exchange regulations limit or eliminate the health plan's ability to underwrite coverage. However, Landacorp's chief actuary and expert in risk identification, Jim Dolstad, presented a model and key components for succeeding in this new, emerging market. Dolstad's plan points out specific opportunities to address clinical and lifestyle risk together to improve health and lower costs and presented the data to support his strategies.
Dolstad capitalizes on 20 years of healthcare data and experience with large employer groups and populations through his work with Carewise Health. This experience brings health plans a foundation for understanding the health exchange landscape and identifying and targeting individuals who are at-risk or costly. But clinical factors are not the only drivers of member risk.
"Clinical factors are not the only drivers of member risk. Three percent of the population typically drives 50 percent of the healthcare costs," said Dolstad. "Identifying that three percent of the population is an excellent first step. Another essential step is understanding that 70 percent of health problems are caused by lifestyle choices, such as smoking, poor eating habits, and lack of exercise," continued Dolstad. "These choices can be positively impacted and influenced when health plans and providers share information and collaborate to inform and guide members. Improvements in blood pressure, weight, blood glucose levels, and adherence to medications are some of the clinical measurements that prove behavioral changes positively impact the overall health of a member."
According to Dolstad, there are five crucial components to a successful health exchange strategy:
- Operate a two-dimensional strategy to manage health that includes clinical and lifestyle risk assessment and intervention;
- Continue to focus on those most ill, but, also invest in the healthy;
- Implement a robust infrastructure to support integrated delivery of a wide range of programs;
- Mitigate the migration of lifestyle risks to diagnosed conditions; and
- Use non-traditional metrics to measure success.
For more information about how health plans can take advantage of the health exchange opportunity, you can request a free download of the full presentation by contacting Landacorp at [email protected].
Landacorp, a Carewise Health affiliate, has been creating software solutions for health plans and healthcare-delivery organizations for more than 25 years. Proven to perform in the largest user groups, the company's CareRadius Suite automatically identifies the right members for timely and cost-effective intervention; enables highly efficient collaboration among providers, members and health plans; and delivers clinical care tools that improve member health.