-- Pilot study with UniCare shows RHI Direct-to-Member program delivers 2.4:1 ROI for the GIC
-- National Business Group on Health features Resolution/UniCare case study
Results of a pilot study undertaken by Resolution Health, Inc. (RHI) and UniCare (a division of Wellpoint) for the Commonwealth of Massachusetts Group Insurance Commission (GIC) document that RHI's Direct-to-Member(TM) (DTM) Communication program reduces both medical and pharmaceutical costs and improves quality of patient care, with a return-on-investment (ROI) of 2.4 to 1.
"The GIC encourages use of innovative ways to improve quality and reduce costs," says Bob Sorrenti, M.D., Medical Director, UniCare. "I believe we have demonstrated that Resolution Health's Direct-to-Member Communication Program delivers the meaningful clinical improvements and cost savings GIC is looking for."
Dolores Mitchell, Executive Director of the GIC adds, "We have been pleased with the results of the Resolution Health DTM program, which has delivered measurable clinical benefits to our members, and has also provided financial benefits to the plan. This is an approach, working with both consumers and their physicians, that I can support." The GIC provides medical, dental and other employee benefits to the Commonwealth's employees and retirees, their dependents and survivors.
The results of this pilot program were featured in a recent Webinar hosted by the National Business Group on Health (NBGH), which drew participants from Fortune 500 and large public sector employers, employee benefits consultants and other industry influencers and decision-makers.
According to Helen Darling, President of NBGH, "This approach is based on the kind of innovative analysis and decision-support tool that leading edge employers and purchasers are using and will increasingly need to drive healthcare quality, improve patient safety and ensure that patients are getting evidence-based healthcare. By helping to engage the patient, we increase the likelihood that we will be paying for the best and most appropriate care, that the patients will be satisfied with the care and that we will reduce waste, as well as unnecessary and inappropriate care."
RHI CEO Earl Steinberg, M.D., M.P.P., a nationally known expert in evaluation and improvement of the quality and efficiency of healthcare, states, "These results further substantiate the value of our DTM program. By providing personalized information to patients regarding specific opportunities to improve quality and reduce out-of-pocket expenses, DTM improves compliance with best clinical practices, as well as a plan's formulary."
Dr. Sorrenti adds, "These individualized communications, which are provided in a simple, straightforward format, clearly influence healthcare decisions. Resolution's DTM program has generated compelling improvements in compliance with 10 specific clinical practice guidelines and has increased compliance with various economic incentives built into the GIC's prescription drug benefit plan."
The findings from the UniCare/GIC pilot came from a prospective, non-randomized, matched cohort study that was conducted over a 12-month period.
The patient-specific and clinical issue-specific communications included in RHI's DTM Program provide information regarding:
-- quality improvement opportunities related to evidence-based guidelines for members to discuss with their physicians;
-- specific ways for the member to reduce prescription co-payments and obtain discounts on non-covered services and products;
-- health plan-specific programs that might benefit the member, given his/her clinical history;
-- the cost of recent healthcare service utilization.
The Group Insurance Commission (GIC) was established by the Massachusetts Legislature in 1955 to provide and administer health insurance and other benefits to the Commonwealth's employees and retirees, and their dependents and survivors. The Group Insurance Commission is a quasi-independent state agency governed by an eleven-member Commission appointed by the Governor. Approximately 264,000 people are enrolled in GIC plans. The mission of the GIC is to deliver high quality care at a reasonable cost. Visit http://www.mass.gov/gic/.
UniCare serves 1.6 million medical members and is an operating subsidiary of WellPoint, Inc., the largest publicly traded commercial health benefits company in terms of membership in the United States. WellPoint offers a broad spectrum of quality network-based health products including open access PPO, POS and hybrid products, HMO and specialty products. Specialty products include pharmacy benefit management, dental, utilization management, vision, mental health, life and disability insurance, long term care insurance, flexible spending accounts, COBRA administration, and Medicare supplements. Visit www.unicare.com.
About Resolution Health, Inc.
Resolution Health Inc. is a healthcare data analytics company that produces and implements targeted patient and physician communications and profiling analyses to help companies reduce healthcare costs and improve healthcare quality. RHI clients include health plans/insurers, large self-insured employers, third party administrators, pharmacy benefit management companies, and benefit consultants. Visit www.resolutionhealth.com