Kanawha HealthCare Solutions [KHS], a TPA division of KMG America, has recently completed a study of its medical management and patient outreach programs that shows a decrease in costs and concurrent improvement in member compliance in risk areas including Diabetes, CAD, Asthma/COPD and women’s health issues.
Lancaster, SC – Kanawha HealthCare Solutions [KHS], a TPA division of KMG America, has recently completed a study of its medical management and patient outreach programs that shows a decrease in costs and concurrent improvement in member compliance in risk areas including Diabetes, CAD, Asthma/COPD and women’s health issues.
According to KHS CEO Dale Vaughan, a study covering the period from February 1, 2004 – January 31, 2006, showed that the annual trend in allowed medical claims realized was [-]9.31%, based on analysis of 156,00 member-months and over $60 million in allowed claims.
In addition, quality of care indicators for members were greatly improved due to KHS medical management outreach programs, showing compliance improvements for members with Diabetes, CAD, Asthma/COPD and for women’s health issues. Also, utilization of emergency rooms and hospital admissions dropped, in the population reviewed, reflecting the impact of behavioral changes on utilization and the overall trend.
“We find these results very encouraging. They demonstrate it is possible to simultaneously reduce the costs and improve the quality of health care. We’re delighted to be able to share these significant findings with our members. These results are a good example of what can be done – and what is being done – to assist in controlling health costs and improving participants’ health.” said Mr. Vaughan.
The programs upon which the study was based, Healthy Coaching, Healthy Invitations and Case Management, are part of a suite of medical management products [Healthy Solutions] that KHS provides in addition to claims administration.
Healthy Coaching and Healthy Invitations are designed to first identify and then counsel members “at risk”, using D2 Hawkeye, a leading provider of medical data reporting and analytic solutions and KHS’ analytics partner.
D2Hawkeye, through the use of intensive data mining techniques and in conjunction with KHS, rapidly integrates data on eligibility, medical and pharmacy claims, health risk assessment and case management, to predict individual and aggregate risk.
These key KHS outreach programs were a critical part of the change in behavior reflected in the study and are available for purchase, to self-funded groups who use KHS’ services. The purpose of Healthy Coaching and Healthy Invitations is two fold: enabling members to manage their conditions and practicing compliance, for maximizing health through education and counseling. Healthy Coaching and Healthy Invitations are also designed to help employers manage potential excessive healthcare costs.
Another key program that is part of KHS Healthy Solutions includes case management outreach, for acute and episodic issues.
For more information, please contact Amy Siwik, Director of Marketing, KHS, at 800.635.4252, ext. 5760.
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