The REAL Difference

Our analytic & data mining process takes into account all factors of each client members health profile – biometrics, drug adherence,  HRA, risk factors and historical claims. The typical client can expect overall population risk score to drop 8-10% in the first year. We utilize our own RN’s each having a minimum of 15 years of experience. Our RN’s have diverse and experienced backgrounds with specialties ranging from ICU and ER, Maternity and Neonatal, Cardio-Pulmonary and Surgery, Oncology and Infectious Disease, Orthopedics and Rehab, and of course, Preventative Health and Wellness. Each of our RN’s has exceptional PR skills and experience teaching employees, patients, and families to help incorporate more engagement from employees. Because of a more personalized approach and a significantly lower Manager to Member ratio, our “Engagement Rate” is approximately 97%, versus the average rate of 20% for large case management outfits.

Our Process

• Approximately 90 days for RHS to enter employee data pulled from client carriers
• Approximately 48 hours to send out initial population data:
  • High COST population
    1. Using Total Lifetime Paid
  • High RISK population
    1. Using Milliman Advanced Risk Adjuster Score
  • Estimated high risk population based on biometric results & claim info
    1. BIO for short
• Immediately initiate contact with high COST employees starting with the highest cost and working down and offer disease management.
• Immediately initiate contact with high RISK employees starting with the highest risk and working down and offer disease management.

• Immediately initiate contact with BIO’s and offer disease management if appropriate or preventative health coaching if it is not (2-3 from each biometric category a day starting with the highest and working down):
  • Elevated cholesterol
    1. Elevated triglycerides
    2. Elevated LDL/Low HDL
  • Elevated blood pressure
    1. Tobacco cessation
    2. Medication compliance
    3. Nutrition compliance
  • Elevated blood sugar (preferably HGBA1C)
    1. Medication compliance
    2. Nutrition compliance
• Reassess populations every 60 days as their medical claims are updated every 60 days in RHS analytics system
• Reassess population risk score and population cost every 6 months to evaluate progress
  • Reassess BIO’s annually to evaluate effectiveness of health coaching
• The key to success is RHS having updated contact info for all clients’ employees