SCIOinspire's Program Evaluation provides the health plan with a structured, objective view of the opportunities and issues facing its various care management programs. We address the essential components of these complex, multidisciplinary programs and identify if and where improvements can be made for improved outcomes and reduced costs.
Using existing utilization and medical loss ratio data and outcomes analyses, activity reports and program materials, SCIOinspire will address the following questions:
- Is the health plan effectively targeting high-risk, high-cost members for prospective care management?
- Are current processes sufficient for identifying and acting on high-cost individuals?
- Are there untapped opportunities for reducing costs by enhancing or reengineering the care management programs?
- Does the data management and integration capability adequately support the focusing and reporting of the care management programs?
SCIOinspire offers a three phase approach to evaluating care management programs. Each of these phases are distinct from each other and can be purchased separately. The evaluation can address the various programs such as utilization management, case management, disease management and wellness and health education.
Phase 1 is an evaluation of the program's structure and function including program scope and design and the critical program functions.
Phase 2 is a focused cases audit, building on the work done in Phase 1. SCIOinspire will further identify specific opportunities for, and barriers to, effective care management.
Phase 3 is an assessment of the data management capability, the program focusing and targeting process and reporting of program outcomes.
- Independent evaluation of the adequacy of the care management programs to meet the needs of the health plan, members and regulators
- Specific suggestions and recommendations on improvements to your programs that will increase cost savings through improved efficiencies and focus
- Care Management Program Evaluation
