RISK MANAGEMENT AND WELLNESS

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Risk Management and Wellness Associates (RMWA)

RMWA is our unique risk management specialty staff of nurses, underwriters, actuaries, and data analysts. Our model merges underwriting, nurse expertise, data analytics, predictive modeling, wellness, risk management, and custom intervention in a way not available from any other model. The result is a service addressing four needs at once: underwriting, data analytics, wellness, and care management.

Group Case Manager

The RMWA program is based on a whole new concept - a “Group Case Manager”: Group Case Manager is an entirely revolutionary concept. This is a nurse/underwriter who first underwrites the group, then is assigned to the group as the health and wellness manager and acts as the cost control officer. RMWA also deploys actuarial analysts to assist with data warehouse analytics, reporting, and interpretation to complete the loop between risk assessment, risk abatement, and risk management.

The Group Case Manager is singularly charged with containing costs within the group while increasing the health and productivity of the workforce. The Group Case Manager will address the issues that drive costs and merge clinical and advocacy expertise with hard nose actuarial science and data analytics. They will also oversee and make maximum use of the resources already available to the group.

The Job Description of the Group Case Manager is Simple

Help reduce an employer's immediate costs while maintaining appropriate care.

Promote wellness.

Enhance the value of the benefit plan.

The service is supplemental to any other paid service in place such as Utilization Review, Biometric Screening, Nurse Call Line, Case Managers, or Wellness Coaches. The RMWA team will work to enhance and promote any of these services purchased by the employer, not replace them. Our goal is to oversee the diverse and isolated activities, ensure they are taken full advantage of, and make sure employees understand their resources and use them properly.

New Twist to Risk Management - Lower the Renewal

The goal of our risk management is to lower the renewal changes. The most evident measure of the success of the Group Case Manager will be the size of the renewal.

Employers desire low cost and stable renewals. The nurse Group Case Manager will view each employer client from that perspective, and be the client's advocate at renewal time. Our focus is to identify and address the things within a group that could have an adverse effect on the renewal, or assure that another vendor is addressing those things.

If wellness initiatives are working, the Group Case Manager can make sure the employer gets appropriate credit.

The best way we will keep our customers will be to lower their costs. All the activities of the nurse Group Case Manager will have one eye on helping the participants and one eye on the renewal.

The DataSmart Clinical Solution Tool®

Contribution health is a distributor of DataSmart Analytics

DataSmart goes beyond the integration of medical and pharmacy claims data, and includes participant health assessment questionnaires, lab, and biometric values. This proactive approach incorporates predictive modeling, regression analysis, and employee engagement to reduce future claim costs.

The DSS Clinical Solutions Tool (CST) Includes online reporting (and readily-accessible flat files) to facilitate precise financial control and effective risk management.

Claim and Renewal Projection Modeling

PRISM is a dynamic monthly claim projection system and dashboard that updates the claim outlook and estimated renewal for the next policy year. The model can be refreshed with the data from each monthly claim data summary.

The PRISM service will turn routine self-funded medical “agg reports” into dynamic claim projection tools for your self-funded customers.

Input

Enter 3 simple data elements each month:

  • 1. Employee count
  • 2. Paid Claim total
  • 3. Shock claim amounts

Output

The claim projection for the current year and following year is updated.

Features:

  • Branded product available
  • Enter projected or actual renewal
  • Back room support or fulfillment
  • Custom benchmarking page unique to your agency
  • Six-page report

Wellness

The unique perspective of our wellness, data analytic, and underwriting company, Risk Management and Wellness Associates (RMWA), is based on these simple observations: Wellness and population health initiatives are wonderful things and have noble goals, but the promised financial returns are not based on good actuarial science, which results in widespread skepticism and uncertainty regarding the claims of wellness promoters.

Financial gains from successful wellness activities are generally out in the future, almost impossible to measure, and confined to a narrow sector of the population. Financial problems are compounded by across-the-board incentives that generally surpass the potential value of lower costs even in the best of circumstances, especially for younger workers. Ironically, the best wellness ROI today might come from re-assessing and reducing the excessive investment in wellness incentives and other hard costs.

Wellness programs and aggressive claim control strategies are an essential component for self-funded employers. RMWA, by combining smart interventions and data analytics with actuarial science, offers a superior approach compared to most of the questionable practices in the marketplace.