How we Create the Best Performing Employer Health Plan Management
We reduce the complexities associated with delivering care.
We take conventional health care resources and deploy them in a superior integrated design.
We fundamentally simplify and align services and payment.
We deliver immediate savings and dramatically improve health care outcomes.
Member engagement is fundamental to a successful employer health management program and yet low engagement rates are one of the top reasons employers seek Vigilant Health solutions. Vigilant Health’s model focuses on plan data, trends and member patterns to create and execute plans of care for each health plan and member. We align incentives with comprehensive health and well-being programs. We provide a portal tool to members that include resources for health education, incentive management, health records, goal setting, health reminders, and additional touch points for access to a health care provider. We make sure members are seen quickly, at no cost, and for as long and as often as they need. All program components are designed to work harmoniously at making a positive and valuable connection, while guiding the member towards a path of improved health and well-being.
Health plan medical claims are the best place to determine where overuse and underuse of the health system exist within a health plan. Vigilant Health’s proprietary software identifies the various high, intermediate, and low-cost claimants as well as utilization of services, such as emergency room visits, unnecessary and over-priced procedures, and out of network services. The Vigilant Health software also creates for providers, the equivalent of a comprehensive medical history for each patient patient, a report which is essential for optimal care and almost never available otherwise. The health record and medical claims data combines to uncover the appropriate care strategies for the entire employer health plan as well as its individual members. This data then allows Vigilant Health’s Nurse Practitioner Navigators to guide each patient through the entire care process including timely scheduling and ancillary care, such as imaging and lab work, to ensure members are informed as to which providers and services are offered as part of their plan.
Chronic Disease Management
On average, 70% of employer health plan medical costs can be attributed to chronic diseases. The current healthcare system and conventional clinic model limit the ability of providers and members to be successful in gaining control of chronic diseases. Current chronic disease protocols put the responsibility of disease management in the hands of the member, when, chronic conditions truly require extensive oversight and additional resources for a member to gain control.
Vigilant Health’s proprietary software informs providers on the best plans for care for members affected by chronic disease. In addition, Vigilant Health’s Nurse Practitioner Navigators and Health and Well-Being Coaches proactively work with each member as a partner on their journey to disease control.
The complexities of the healthcare system often lead to overuse, underuse, and incorrect use. Many times, this is caused by confusion over what benefits are included in a member’s plan. HR/Benefits can also become burdened by member inquiries regarding how to utilize the plan for their needs.
Vigilant Health’s Nurse Practitioner Navigators work with each member on navigating the employer’s health care plan. They are available for questions regarding care whether it’s related to the formulary, network providers or more, and to assist in scheduling, and timely coordination of care.
Personalized Care Team
Vigilant Health’s personalized care team includes community physicians, who utilize an employer’s Vigilant Health onsite clinic to enhance their ability to reach into the localities they serve. In addition, Nurse Practitioner Navigators, Nurse Practitioners, and Health Coaches collaborate with the clinic’s community physicians to deliver individualized patient care management. Vigilant Health’s proprietary software provides each clinician a comprehensive medical history of each patient at each encounter, information that is not otherwise typically available but is essential to delivering optimal care and addressing the overall health of members. As a personalized care team, Vigilant Health provides member guidance on the best providers to ensure coordination of care at all levels. This cohesive team approach, informed by the use of comprehensive claims and utilization data, results in decreased insurance and reinsurance rates, while getting patients to utilize the overall healthcare system according to the plan and most important, to best suit each member’s individual needs. Vigilant Health’s personalized care team also provides members with unlimited access to care at no cost to members.
The Vigilant Health team works with each client to develop a customized and comprehensive health management program based on our findings and deploys it with:
Participation by community physicians. Local primary care physicians are included in the program and empowered through shared management, the exchange of actionable information, and participation in economic rewards. All primary care physicians in a community are invited to participate.
Nurse Navigators who work with health plan members and community providers to ensure proper medical care and implement appropriate and effective health improvement programs. Beyond case managers, Vigilant Health's distinctive nurse navigators are nurse practitioners and providers.
The clinic provides easy, convenient, and cost-free access for health plan members, and becomes a trusted resource for those members because of the personal care of the clinic providers. The staff at the clinic also ensures health plan members are connected to the best providers in the community to receive care.
We create a data warehouse and provide data analytics for each client as a tool to reduce plan costs and improve the health and productivity of its employees and dependents. We apply this information through trained clinicians and our integrated programs to bridge the gap between information and medical management.