	High Impact HealthSCOPE Benefits, through the use of focused medical management, protects your medical benefit dollars without compromising patient care. Our interactive medical management programs allow us to supervise and evaluate patient care before, during, and after the episode of care. Our comprehensive series of medical management programs include HSB High Impact Integrated Population Management, HSB HealthWatch. Utilization Management, Case Management, Disease Management, Demand Management, Telephonic Referral, Mental Health/Chemical Dependency, and Special Beginnings/High-Risk Obstetrical. HSB HIGH IMPACT INTEGRATED POPULATION MANAGEMENT HSB High Impact Integrated Population Management provides new tools for patient identification and medical management across the health care continuum. In addition to event-based identification of patients, HSB High Impact adds sophisticated, clinically based screening tools and methodologies to predict high-risk patients proactively. Early identification is critical to effective proactive medical management. It is HSB High Impact’s goal to make a positive difference in the quality outcomes for members and to minimize the associated costs for both the member and plan sponsor through proactive education and effective health management from HSB’s proven Care Management staff. The High Impact program allows care management intervention prior to a catastrophic event occurring in a person’s life and to assist the person in navigating the healthcare system if a catastrophic event does occur. HSB High Impact provides a continuum of integrated intervention methodologies ensuring the highest level of service at the earliest opportunity. Case Identification HSB High Impact supplements the current model of patient identification through inpatient admission or referral authorization with sophisticated and multi-disciplinary tools and processes – designed to identify patients that would never have been identified before, but who are likely to have future high cost and intervenable healthcare needs. • Predictive Modeling: Accuracy in forecasting high-risk members is essential given the limited resources for case management. Identification of the critical 1 to 2 percent of members that are the greatest risk for high cost provides an excellent opportunity for enhancing health plan performance and in avoiding preventable healthcare costs. HSB’s High Impact program utilizes the artificial intelligence driven predictive software modeling to identify the high-risk members and the root causes that drive these medical costs. Knowledge of these key drivers enables High Impact to focus medical management resources on the specific diseases and processes that will influence your future costs. • Prospective Claims Analysis: High Impact utilizes your claims experience and history as an important data source to support the identification of members at risk for high cost. This information is an input source to the predictive modeling. High Impact Management Once identified as a candidate for High Impact, members will be assigned a Care Manager who will work with the patient to ensure the highest quality of care in the most appropriate setting. This Care Manager will be responsible for monitoring all of the patients’ healthcare activities. High-risk members will also be targeted for additional support services, to ensure the most effective management of their medical needs. Examples of these services include: • Home health visits for specific assessment needs • Medication management • Disease specific mailings, as needed • Clinical outbound reporting to support their physician relationships High Impact includes an aggressive holistic management approach for these special needs members. Each week, a multi-disciplinary team of care managers, utilization managers, network managers and benefit specialists will meet to review the activity and needs of this patient population. The goal is to ensure the seamless integration of all aspects of the High Impact program, to maximize the efficacy of the interventions with the patients, and to manage all health care costs. Back To Top

High Impact

HealthSCOPE Benefits, through the use of focused medical management, protects your medical benefit dollars without compromising patient care. Our interactive medical management programs allow us to supervise and evaluate patient care before, during, and after the episode of care. Our comprehensive series of medical management programs include HSB High Impact Integrated Population Management, HSB HealthWatch. Utilization Management, Case Management, Disease Management, Demand Management, Telephonic Referral, Mental Health/Chemical Dependency, and Special Beginnings/High-Risk Obstetrical.

HSB HIGH IMPACT INTEGRATED POPULATION MANAGEMENT
HSB High Impact Integrated Population Management provides new tools for patient identification and medical management across the health care continuum. In addition to event-based identification of patients, HSB High Impact adds sophisticated, clinically based screening tools and methodologies to predict high-risk patients proactively. Early identification is critical to effective proactive medical management.

It is HSB High Impact’s goal to make a positive difference in the quality outcomes for members and to minimize the associated costs for both the member and plan sponsor through proactive education and effective health management from HSB’s proven Care Management staff. The High Impact program allows care management intervention prior to a catastrophic event occurring in a person’s life and to assist the person in navigating the healthcare system if a catastrophic event does occur. HSB High Impact provides a continuum of integrated intervention methodologies ensuring the highest level of service at the earliest opportunity.

Case Identification
HSB High Impact supplements the current model of patient identification through inpatient admission or referral authorization with sophisticated and multi-disciplinary tools and processes – designed to identify patients that would never have been identified before, but who are likely to have future high cost and intervenable healthcare needs.

• Predictive Modeling: Accuracy in forecasting high-risk members is essential given the limited resources for case management. Identification of the critical 1 to 2 percent of members that are the greatest risk for high cost provides an excellent opportunity for enhancing health plan performance and in avoiding preventable healthcare costs. HSB’s High Impact program utilizes the artificial intelligence driven predictive software modeling to identify the high-risk members and the root causes that drive these medical costs. Knowledge of these key drivers enables High Impact to focus medical management resources on the specific diseases and processes that will influence your future costs.

• Prospective Claims Analysis: High Impact utilizes your claims experience and history as an important data source to support the identification of members at risk for high cost. This information is an input source to the predictive modeling.

High Impact Management
Once identified as a candidate for High Impact, members will be assigned a Care Manager who will work with the patient to ensure the highest quality of care in the most appropriate setting. This Care Manager will be responsible for monitoring all of the patients’ healthcare activities.

High-risk members will also be targeted for additional support services, to ensure the most effective management of their medical needs. Examples of these services include:

• Home health visits for specific assessment needs

• Medication management

• Disease specific mailings, as needed

• Clinical outbound reporting to support their physician relationships

High Impact includes an aggressive holistic management approach for these special needs members. Each week, a multi-disciplinary team of care managers, utilization managers, network managers and benefit specialists will meet to review the activity and needs of this patient population. The goal is to ensure the seamless integration of all aspects of the High Impact program, to maximize the efficacy of the interventions with the patients, and to manage all health care costs.