The Tucker Difference: inVentiv Medical Management ™ and iHealth™
inVentiv Medical Management ™ (IMM)* - A Component of Tucker Administrators’ Employee Benefit Risk Management Program
* formerly AWAC®
80% of the cost of a self-funded employee health plan is invested in claims, and the real savings are possible when the cost containment effort is applied to claims management rather than focusing solely on reinsurance premiums or administrative fees.
What is inVentiv Medical Management ™?
inVentiv Medical Management ™ Identifies and treats medical risks before they escalate to catastrophic claims, effectively negotiating with providers of medical services and products for best prices, detecting billing errors, and isolating patterns of fraud or abuse will directly ultimately resulting in lower claims costs and healthier patients. This process is vital to a plan’s long-term financial health.
How does inVentiv Medical Management ™ work?
inVentiv Medical Management ™ uses a proprietary physician-created electronic surveillance system with over 80,000 clinical and financial algorithms. This system cross matches member claims and related data to uncover current and future opportunities for cost reduction and improved care. Board-certified physicians, nurses and other health care personnel evaluate the identified cases and develop patient-specific strategies.
How does inVentiv Medical Management ™ identify cases for analysis?
- Downloads all member claims data, prescription data and precertification records from Tucker Administrators
- Cross-references that data to its database of advanced algorithms
- Compares data to over 50 million claims and over 90,000 individual cases; inferring outcomes
- Flagged cases reviewed by board-certified physicians that recommend possible actions
- inVentiv Medical Management ™ board-certified physicians then effectively negotiate with providers of medical services and products for best prices beyond any network discounts
- Detects billing errors,
- Isolates patterns of fraud or abuse
- This process is done with all self-funded plan claims submitted to Tucker Administrators every day, before the claim is paid
iHealth™ - A Component of Tucker Administrators’ Employee Benefit Risk Management Program
What is iHealth™?
Many of the most costly and deadly illnesses known today are either preventable through education and life-style change, or curable with early detection. iHealth™ is a program is designed to provide pertinent and reliable information to improve one’s overall health status. iHealth™ uses inVentiv Medical Management ™ data to identify individuals who may need additional information or advice on maintaining their optimal health and wellness.
How Does iHealth™ Work?
Primary Prevention
- Performs an inVentiv Medical Management ™ analysis of medical claims and provides members with customized recommendations for certain wellness screening tests
- Provides wellness guidelines for all employees and their dependents, customized for age and gender and include a recommended schedule of preventive visits, blood tests (e.g. cholesterol level) and immunizations.
- Provides age and gender specific guidelines for the prevention and early detection of the most common cancers including breast, colon, prostate and lung cancer. Important screening tests may be recommended in accordance with guidelines developed by the American Cancer Society and other experts.
- Distributes the semi-annual iHealth™ newsletter that includes seasonal health information (e.g. skin cancer prevention and the use of sunscreens in the spring edition), regular updates to the preventive guidelines, and articles specific to common problems (as noted in the inVentiv Medical Management ™ data.) and access to the iHealth™ website.
Specialty Care
In addition to Primary Prevention, members with certain specific diseases or risk factors identified by AWAC® for intervention and management. These include:
- Diabetes
- Asthma
- Coronary Artery Disease
- Hypertension
- High Cholesterol
These high-risk members enter the Specialty Care Program for individualized disease monitoring and nurse coaching. In addition to the inVentiv Medical Management ™ analysis, members with one or more listed illnesses can be identified via the Workplace Medical Risk Questionnaire for new employees and dependents.
Members receive information and guidance in several ways:
- Members will be contacted by phone, letter or e-mail by the RN Health Consultant and offered customized education and counseling.
- Disease-specific education will be provided through a combination of printed materials and web access.
- A comprehensive listing of relevant resources, including websites for additional education and self-help activities, will be provided.
- The RN Health Consultant will schedule periodic follow-up calls to selected employees and dependents.
REPORTS
- Tucker Administrators and the employer groups are provided periodic reports that indicate the activity of their employees within the various aspects of iHealth™.
- The reports demonstrate the number of clinical interventions by the RN Health Consultant, as well as specific disease prevalence within their employee population.
- The reports will detail each group’s collective adherence to key recommended tests in the Wellness Guidelines.
- This data may suggest additional group and/or disease specific interventions that may be indicated.
