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About > Challenges

What Challenges are Faced by Plan Sponsors Today?

Data and Information	Health Management	Claims Payment
Limited or no health care data available from carriers or other vendors If data is received, it’s typically in raw format There is no useful vehicle to assemble, store & interpret data even if it becomes available What good is data if you’re unable to use it? There is no central repository No one entity is able to diagnosis the problem(s) Plan sponsors are unable to manage what they can	Reactive and based on retrospective Rx and medical claims data Patient is identified after the fact, it’s too late. Adverse and expensive medical events already occurred A member at high or moderate risk is seeing multiple physicians, has 4-8 unique illnesses and taking 8 to 12 different medications. Most programs focus on 5-6 therapeutic classes. Some firms take the data and format it, but provide no action. Traditional cost-based health & wellness plans	Typical claim in, claim out, little to any management Fully insured plans allow for no plan management, carriers need to protect revenue stream Existing self funded; plan appears to be “ASO;” but the carrier jams the self funded plan into a fully insured arrangement Claims viewed at $800 and up Primarily focus on network discounts

How Does WellNet Address Each Challenge?

Data and Information	Proactive Outreach	Medical Management
Interpret the data Create actionable solutions Central data repository to store & interpret data Transactions are real time Rx data is 95% predictable of future risk…use it Make all data available on one platform WellNet provides data and intelligence based analysis	High and medium risk members are engaged by specialized RN Care Manager and a “Care Team” (physicians, pharmacists, nutritionists) to assist in the management of identified medical conditions. Care Manager flags member immediately and outreach begins. Focus on the member body system, identifying over 60 condition categories	Custom claims processing platform and network Lower claim cost adjudication More frequent export of claims data to repository for claims analysis & immediate action for prevention Proactive medical management Claims viewed at dollar 1 and up Members are healthier, claims cost are less as proactive disease and care management has occurred Stop-loss rates reduced
Preventive	Predictive Modeling Technology
Referral to Care Management based on predicted risk instead of medical claims allows WellNet to mitigate and often prevent high cost events. Low risk members are also assisted in order to maintain an optimal state of health and embrace behaviors that support a healthy lifestyle.	Uses real-time Rx claims to identify risk levels within the member population. A forecast of high claims probability and medical costs. Ability to isolate the appropriate members with 99% confidence rating that right member is reached early Medical claims, lab values and self-reported data can also be integrated into the modeler.