Health plans today are faced with the challenge of managing and reducing costs while improving quality of care and health outcomes of their patients. To address this challenge, health plans are shifting more and more towards a model of coordinated care, aligning provider reimbursement with quality care, while also providing affordable coverage, better access to care and more choices for their patients.
As healthcare costs continue to rise, health plans are also under increasing pressure to control expenses while managing demands for chronic, high cost populations. Treating those with co-morbid conditions accounts for 30 percent of the total US healthcare spend each year. In addition, those with co-morbid conditions have a high prevalence of behavioral health issues, increasing costs even more. To contain costs and enhance overall population wellness, health plans need to identify high risk candidates, build effective intervention programs, and measure and track the effectiveness of these programs.