With the employer, NSH structures dual-choice, incentive-based plan design that
monitors compliance to nationally recognized guidelines to
preventive care and chronic disease management. Depending on
employer preference, the impact of compliance/non compliance can
include:
- Forced annual movement into a increased cost/sharing plan design
- Continuation of medical benefits
The heart of this program is educating members on the benefits of compliance as well as the adverse effects of
non-compliance. This communication process is important during both
the open enrollment period and throughout the year.
The Process — at the plan effective date, North Star Health establishes a
wellness disease record (WDR) in HITS for
each employee based on historical claims data and other demographic
information (e.g. age, sex, etc.). Once the WDR is created, the
NSH
care management staff proactively manages member compliance to
established medical protocols (WDR). This proactive
management is coordinated through a team of nurses and physicians
with a goal of overall employee health.
If the member/employee is non-compliant with their protocols,
they are notified and allowed an appropriate correction window. If
non-compliance continues, they are automatically moved into the
employer chosen option (either alternative plan design or no
benefits).
See sample
incentive-based plan design.
Click here to learn more about the wellness disease
record
(WDR)
