iHealth™ is a multi-level, comprehensive wellness education program for insured members and their dependents.  Level 1 consist of an age and gender specific schedule of preventative screenings and a semi-annual iHealth™ newsletter with pertinient health information.  Level 2 is a select monitoring program for members with specific diseases or risk factors.  These members receive customized education and counseling, a comprehensive list of relevant resources, and contact from the RN Health Consultant who is able to monitor status and compliance through AWAC®.  In addition to member iHealth™ services, TPAs and the employer groups are provided periodic reports concerning members’ activity within the various aspects of iHealth™.

Most employers and their employees are despartely searching for health plan management that will provide necessary protection and stability at an affordable cost.  Double-digit increases in health insurance premiums have companies scrambling to reduce claims expenditures.

There is a weapon in the war against soaring health care costs. The AWAC® (Advanced Warning and Containment®) medical management system of AWAC®.MD

AWAC® was selected by The Center for Health Transformation as a technology that will change the future of health care in America.

Most employers and their employees are despartely searching for health plan management that will provide necessary protection and stability at an affordable cost.  Double-digit increases in health insurance premiums have companies scrambling to reduce claims expenditures.

There is a weapon in the war against soaring health care costs. The AWAC® (Advanced Warning and Containment®) medical management system of AWAC®.MD

AWAC® was selected by The Center for Health Transformation as a technology that will change the future of health care in America

AWAC®’s data analysis and clinical logic technology along with its network of board-certified physicians make it possible to monitor health plan utilization, cost of care, appropriateness of care and ultimately reduce the costs incurred.

Because 80% of the cost of self-funded employee health plan is invested in claims, real savings are possible when the cost containment effort is applied to claims management rather than reinsurance premiums or administrative fees.  AWAC® is all about identifying and treating medical risks among members before they escalate to catastrophic claims while also working to manage the everyday cases.

AWAC® is the company’s computer driven data analysis and clinical logic technology.  It was developed for the medical insurance industry by a team of specialist physicians and uses over 60,000 physician-developed clinical algorithms, tens of thousands of actual cases, and millions of claims to electronically identify and stratify risks, infer outcomes, and recommend possible actions.  AWAC® securely downloads and scans clients’ claims data, prescriptions and pre-certification records every night.

Most claims analyst do not have the expertise to identify catastrophic cases early, to recognize fraud, abuse or errors in complicated medical billing, or to effectively negotiate with providers.  But AWAC® does.  AWAC®’s technology analyzes a health plan’s data in order to monitor claims and prescription drug purchase data for activity that may indicate potential catastrophic illnesses, billing inaccuracies, or fraud and abuse patterns.  When the AWAC® system flags a potential health care risk or utilization anomaly, intervention is available through a network of board-certified physicians.

AWAC®’s skilled physicians are able to communicate with attending professionals, manage expensive cases, review billing in a clinical context, and negotiate terms.  Thus, they are able to provide effective medical and financial management to ensure quality care, avoid variances, and contain costs.

With ground breaking technology coupled with the proven physician intervention techniques, AWAC® is a defense system truly worthy of its name archiving a hard dollar savings of over $110,000,000.

AWAC®.MD
Third party administrators, managing general underwriters and carriers know that the greatest impact on a health plan’s costs is from large individual claims.  It is critical to identify these cases early before they escalate into catastrophic claims.  This early detection of catastrophic illness is not only critical to a claimant’s health, it is also absolutely vital to managing and containing costs.  AWAC®.MD offers a series of physician-based, technology-enhanced approaches to identify expensive problem case early and manage them in a way that ensures quality care and best possible pricing.

Procert™ is a precertification system that also downloads information to AWAC® to assist the management of the health care plan.  AWAC® physicians review this data for clinical or financial indicators that would predict the need for case management, early discharge planning, long term care needs, disease management requirements or potential cost containment opportunities such as pre-negotiating services.