A complete view of the patient— "Comprehensive and timely. Absolutely great service!"

Patient Advocacy Services

Plan Performance Reporting

 

Patient Advocates (PA) developed a robust data warehouse that provides clients with unique 3-D perspectives on the health of its member population. Custom reporting can be developed from all available data on a patient. Claims for medical, dental, and prescriptions are stored with biometric data from health screens along with the results of the predictive modeling program to give our nurses a complete patient picture.

In addition to customized reporting, PA provides two standard reports: High Risk and Cost Savings Benefit Analysis.

PA delivers high risk reports for advocacy patients, providing the plan with the necessary health information needed for decision making while protecting the privacy of the patient. High risk reports detail the patient’s claim history and predict future medical needs. The report also notes whether or not a patient is a voluntary participant of any employer-sponsored wellness or disease management program. In the High Risk Report, nurses provide a written narrative updating the patient’s progress and expectations for the future. The High Risk Report is a valuable tool for the re-insurer because of its detailed account of the patient’s past, current, and future medical needs. A complete view of the patient allows greater precision during underwriting process.

The Cost Savings Benefit Analysis report helps a company’s decision maker determine the return on investment for case management charges. The report illustrates the total hours that nurses spend advocating for patients and the corresponding costs to the health plan. Savings is provided to the health plan both in avoided charges and hard savings as a result of advocacy. The Cost Savings Benefit Analysis report shows how much was saved as a result of avoided ER visits or hospital admissions as well as the hard savings realized through direct negotiation with the providers or changes in level of care. The executive summaries provide this information in a one page view that concisely summarizes the results of nurse interventions during the plan year.