• • Which diseases are likely to be most prevalent and most costly for this patient population;
  
  • What's unusual in expected disease incidence and costs for this population; and
  
  • Whether costs for each disease are being driven by high-cost individual cases or high incidence.

Health Plan Medical Directors use this information to:

• Cut Medical Costs. Prioritize and direct disease management and case management efforts for greatest impact;
• 
  Avoid Contract Disasters. Assess proposed premiums based on the strength of network in handling anticipated disease patterns in the group to be covered;
• 
  Anticipate Cost Problems. Identify where medical costs may be especially vulnerable to costly new drugs and therapies;
• 
  Simplify Compliance. Comply with NCQA and employer coalition mandates for risk assessment;
• 
  Strengthen Provider Networks. Plan physician and professional staffing based on expected disease patterns;
  
  Support Troubled Providers. Assist financially ailing medical groups by identifying and assisting with key medical issues in their member populations;
  
  Set Appropriate Targets. Establish realistic and appropriate incentive and bonus targets;
  
  Compare Actual to Expected Incidence and Costs. Identify possible undertreatment/ overtreatment and inadequate reporting; eliminate cost variances based on selection to focus on genuine medical management issues.
  

Health Plan Sales Executives use this information to:

• Win Contracts. Distinguish bids for large contracts by identifying and tailoring programs for an employer's specific population;
• 
  Avoid Contract Disasters. Involve Medical Director in assessing strength of the plan's network in handling anticipated disease patterns before locking in large contract bids;
• 
  Adjust for Regional Variations. Identify differences in employee medical needs in various locations and develop programs and cost-management strategies for each area;
• 
  Improve Customer Satisfaction. Show large employers the disease patterns you expect from their members and demonstrate your commitment to meeting their specific needs;
• 
  Commit to Quality. Compare actual to expected costs for each disease and demonstrate your commitment to improving quality of care.
  

For more information and a sample report, contact Strategic Health Resources® at (818) 952-5130.