At ¶¶Òõ, we believe in finding new and effective solutions that respond to the complex health needs of our members. By combining active local involvement in our communities with a commitment to whole health, ¶¶Òõ has established programs that work to remove many of the barriers facing healthcare consumers. Oftentimes, these successful health management programs are a result of collaborations with community partners and other stakeholders.
How We Do It
¶¶Òõâ€™s Clinical Programs team collaborates with our Enterprise Analytics group to develop a comprehensive portfolio of programs to advance health outcomes for ¶¶Òõâ€™s members. Through deployment of the Identify, Stratify, Manage, Measure, and Disseminate (ISMMD) model, each clinical program is developed by leveraging cutting-edge clinical guidelines, evidence-based best practices, and data science. Implementation of each of the clinical programs is measured through continuous monitoring, benchmarking, and a rigorous goal-setting process. Three examples of ¶¶Òõâ€™s clinical programs are listed below. They continue to set the industry standard in quality and clinical program development by emphasizing the highest level of methodology and analysis.
¶¶Òõâ€™s multipronged FluventionÂ® campaign was designed to promote vaccinations as the key to flu prevention. By increasing annual influenza vaccination rates in high-risk members, health-related complications and excess healthcare costs are greatly reduced. The FluventionÂ® program empowers health plans to improve overall flu vaccination rates by distributing education materials to members and providers enterprise-wide, as well as increasing access to facilities that provide flu vaccinations. The program has a proven track record of increasing flu vaccination rates among ¶¶Òõâ€™s membership year-over-year.
Start Smart for Your BabyÂ®
With a focus on pregnant members, new parents, and their babies, ¶¶Òõâ€™s award-winning education and outreach program, Start Smart for Your BabyÂ® (SSFB) is an evidenced-based maternity program that leverages advanced analytics to identify and engage members to improve pregnancy and birth outcomes. The program combines predicative data modeling, integrated care management and coordination, disease management, and health education to extend the gestation period and reduce the risk of pregnancy complications, premature delivery, and low birth weight to improve the health of birthing parents and their newborns. Community outreach activities such as baby showers connect members with clinical teams, care managers, and community partners in a fun and engaging setting encouraging a whole-health approach to pregnancy and infant care. The program continues to evolve to further its impact through targeted interventions to address health inequities that contribute to higher rates of pregnancy complications and pre-term births. Several SSFB initiatives have received leading healthcare industry awards, includingÌýCase-In-PointÌýPlatinum Awards.
Impact Brief:ÌýHow Addressing Disparities in Pregnancy Care Leads to Healthier Infants and Parents (PDF)Ìý
The Readmission Reduction program aims to reduce preventable readmissions by working to ensure optimal transitional care from acute and non-acute settings. The program focuses on placing post-hospitalization outreach calls to members to ensure they understand their discharge instructions, plan to follow up with a primary care provider, and discuss medication reconciliation. Additionally, the highest-risk members are linked with a community health worker home-visiting program. Through the implementation of the program, ¶¶Òõ aims to avert 15% of preventable readmissions.