How it works – opportunities for support
Our Whole Person Health SupportSM approach does just that – focus on the whole person. We start by developing an opportunity score for each member. It’s based on health risks, potential future costs, likelihood of engagement and the degree to which our active support can make a difference – the opportunity.
Better information for better results
Until now, health management has focused on people with particular diseases and conditions. That made sense when health plans’ knowledge of members was limited to medical claims, and analytical capabilities were few.
Because our goal is optimal health for all your people – not just the ones with certain diagnoses – we look at a richer set of data to identify opportunities to extend support:
- Medical claims provide health histories
- Pharmacy claims indicate medication compliance
- Self-reported health assessments detail smoking, dietary and exercise patterns, and openness to behavior change
- Member conversations with Blue Cross Health Support staff add context and reveal relationships among behaviors, attitudes, health risks and health events.
All of this information – and more – is analyzed to create a picture of health needs and opportunities across your entire population. The result is the uniquely tailored opportunity score for every single member.
Support finely tuned to each member’s needs
As an example, a person with diabetes doing everything recommended to manage her condition has a lower opportunity score, meaning they need less support. Another person with diabetes who is not taking prescribed medications and hasn’t had recommended tests has a higher opportunity score and receives more support. Rather than treating everyone with a condition the same, support is finely tuned to each member’s needs.
In fact, your employees are surrounded with a rich network of services expressly designed to make a difference in their lives. Whether it’s help quitting smoking, finding easier ways to exercise, making healthy eating more fun or learning new ways to relieve stress and manage complex conditions, our member-centric health support can help.