Insurance Claims Data Integration Drive Preventive Care

A Wellvation client, a large regional healthcare system had historically had low employee utilization of preventative care services in their employers sponsored health benefits.

Their healthcare provider and previous wellness provider lacked the administrative and technical capability to identify, track, and import claims data from a variety of sources to motivate and reward employees and spouses for obtaining age- and gender-specific care.

Objectives

1. Increase utilization of current preventative care benefits
2. Identify emerging health  care needs in the employee population
3. Reduce gaps in care
4. Prevent the onset of disease
5. Reward and encourage employees to become more proactive in tracking and managing their own health.

Methods

1. Identify the preventive requirements based on nationally recognized guidelines
2. Strategically incorporated age/ gender based preventative screening requirements into the well-being program
3. Collaborated with medical insurance providers to facilitate claims data transfer
4. Created an insurance claims data import process with guideposts & safeguards into ManageWell™
5. Ongoing communication  on unfulfilled preventative services 
   
   

*As of 2015, only 8 percent of US adults ages thirty-five and older had received all of the high-priority, appropriate clinical preventive services recommended for them. Nearly 5 percent of adults did not receive any such services. 

— HealthAffairs.org

Results

• Year 1: 50% increase in preventive care services completed

• Year 2: 78% of all participants enrolled in an employer's health insurance plan had at least one preventive care service rendered in the plan year. 30% of participants were 100% adherent to all age/gender based preventative services

About ManageWell™

ManageWell™ by Wellvation is a flexible, full-featured wellness platform that empowers organizations to drive engagement and deliver measurable results—without the limitations of rigid systems.

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