Evidence-based approach. Measurable results. Better outcomes.
Population Health Management and Wellness that Works
Transforming Healthcare Plans Through Data-Driven Population Health Analytics
Turn fragmented patient data into coordinated care strategies that improve clinical outcomes while reducing costs for your business.
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A Few Questions You Should Ask Yourself…
- Disruptive and time consuming insurance company changes
- Benefit reductions including higher deductibles and increased copays
- Increased payroll contributions for employees
If you said YES to any of these questions, there is a BETTER way…
Our Data Driven Health Management
Healthier people. Healthier profits.
Hilb Group is committed to designing targeted programs that actually work and save money.
We combine data analytics with personal attention by our nurses who will intervene to offer you and your employees an effective solution. Using your employees’ healthcare data, our data analytics tools identify latent risks in your employee population. We work with you to develop programs to mitigate this risk and improve the health of your population.
Everyone wins by helping to improve your employees’ health, increasing their productivity and job satisfaction while controlling insurance costs.
How It Works
Meet Gary
Gary is a 60 year old male who has not had a routine physical in 2+ years.
He does not know he has underlying cardiac issues.
Gary's Jouney Without Intervention
Gary’s Journey with Hilb Group Healthy Plan Solutions
Hasn’t seen a doctor in years and has undiagnosed cardiac issues
Diagnosed early with high blood pressure
Doesn't have an effective wellness program that motivates him to become healthy
Flagged as non-compliant with multiple gaps in care in our analytics system
Your health plan’s medical management team hasn’t reached out to him because he’s not a high claimant yet
Has a wellness program that motivates him to get well
Ends up hospitalized for heart-attack and has an open-heart bypass surgery
Hilb Group nurse connects him with your carrier's medical management, and due to proper incentives to participate, he agrees
Has a life altering medical condition that is urgent and may not be able to return to work (disability claim). Hits stop-loss and now he has a Short-Term Disability claim
Becomes a better-informed patient, and closes his gaps in care thereby reducing his risk
Never has a heart attack and remain a productive employee
Never hits stop-loss and avoids a Short-Term Disability claim
Health Plan Impact: $14K
Cost Avoided: $145K
Health Plan Impact: $159K
How Do We Achieve These Results?
Our population health management oversight helps identify at-risk patient populations before they become expensive cases, engage employees in health-promoting behaviors, coordinate care across health systems, and deliver targeted interventions that actually improve outcomes. We help you manage your employees' health while controlling your health plan costs.
We do this by enhancing our clinical team’s power with data-driven strategies.
Clinical Team
Powering Medical Professionals with Data Analytics for Data Driven Decision Making
Our innovative approach leverages the power of healthcare data analytics—risk stratification, identification of gaps in care, predictive healthcare analytics, and prescriptive analytics.
We transform population data, claims data, EHR data, and clinical data into actionable insights for better patient centered care. Then we identify high-risk patients before cardiovascular disease, diabetes complications, or other chronic conditions escalate and increase your health plan rates.
Clinical Management and Early Identification of Health Plan Risks
Our medical staff, who are registered nurses and certified case managers, provide clinical management oversight and coordination with your health plan and healthcare providers to better reach your employees. This means our nurses proactively identify members that should engage with your health insurance carrier’s medical management team (focusing on those with new/emerging risk that carriers often miss), who provide case management, disease management, and coaching.
Our dedicated nurses help your employees navigate complex healthcare situations including:
- Obtaining answers to their personal medical questions,
- Ensuring they receive appropriate medical management support from their health plan,
- Finding solutions for out-of-network providers, and
- Assisting with appeals for denied services.
Ongoing Claims Monitoring and Strategic Support
Hilb Group serves as an independent set of eyes on your company’s claims looking for anomalies and areas for improvement. We ensure the best care is provided while controlling excess claims and improving your employees’ healthcare experiences.
Wellness Compliance Tracking and Benchmarking
As part of our clinical management oversight, we continue to monitor the carrier’s activity to ensure all your appropriate employees are engaged. Leveraging our proprietary health data analytics, we also help you design a proactive wellness plan that can address the health care needs in your group and improve your employees’ health and reduce your organization’s healthcare insurance costs.
Data-Driven Strategies
We leverage your data as well as market data to create effective benefits cost control strategies for your organization.
Informed Stop-Loss Negotiation
One of the most important strategies we use is informed stop-loss negotiation. How? Our clinicians look at high claims down to $25,000 (or any level requested) as well as offer comments and predictions of future claims. Our goal is for our groups to be aware of all high claimants and projected future claims until the end of the plan year or the upcoming plan year. We don’t want any surprises come renewal time.
Using the high claimant report (detailing current treatment and costs) and having access to direct member claims in Cedar Gate allows us to have meaningful conversations with the stop-loss carriers. Stop-loss carriers appreciate this information and often respond with favorable renewals.
Other Data-Driven Strategies
In addition to stop-loss negotiation, we also provide the following services:
- Targeted approaches specific to your population health trends
- Plan design recommendations to maximize value
- Measuring voluntary vs. required wellness program impacts
- Centralized repository for medical, eligibility, and pharmacy data
- Custom views into division, plan, and location data
- Tracking carriers’, Third Party Administrators’, and Pharmacy Benefit Managers’ ability to manage and pay claims
- Identify changes in pharmacy pricing over time
- Milliman’s MARA Risk Scoring to gauge and predict risk
- Data visualization software for client-specific analyses
- Reporting on routine exam, wellness, and medication adherence metrics
- Predictive reporting based on high-risk diagnosis triggers
Our Results Speak for Themselves
We’ve consistently outperform the market benchmarks of our partner – Cedar Gate Technology, a leading data analytics and management system company.
Testimonials
Start Your Population Health Management and Cost Containment Today
Take the first step toward proactive healthcare delivery that improves clinical outcomes while optimizing healthcare costs across your patient populations.
Contact us to schedule your population health strategy assessment.
Frequently Asked Questions
Most healthcare organizations notice enhanced care coordination and patient engagement within 60-90 days, with measurable improvements in chronic conditions management by six months.
No technical expertise required. Our population health platforms are designed for physicians, nurses, and case management teams to use intuitively.
We exceed HIPAA requirements with enterprise-grade security, ensuring all clinical data, claims data, and patient information remain protected throughout the health information exchange process.
Yes. Our data integration capabilities work with major EHR systems, health information exchanges, and existing healthcare technology infrastructure.
Related Products
HR Consulting
Through HR Knowledge, Hilb Group offers Human Resources consulting services throughout the country.
Retirement Services
Our consultants will take you through a proprietary process designed to find you the most appropriate solution, and monitor it regularly in an effort to help you create successful retirement outcomes for your employees.
Healthcare
Like magic, you can increase benefits while reducing total costs. Hilb Group’s licensed professionals will visit to discuss your needs and your budget.
I’ve had a long battle with a difficult respiratory condition which required me to seek out the best treatment possible. And it has paid off. I am so much better due to the amazing efforts by the team at National Jewish Health (NJH) in Denver, CO. And for the past several years, my dedicated Hilb Group nurse has taken on the heavy red tape at Care First to be covered by Care First while under the care of NJH – the #1 Respiratory Hospital in the US (by US News).
While the health benefits to visit National Jewish as an out-of-network provider do exist under our plan, it takes an “Act of Congress” to get Care First to respond to requests, approve, and pay for such extensive out-of-network treatments. Just today, Hilb Group was again successful in paving the way for my annual check-up at NJH with a full range of specialized tests.
I am forever indebted to Hilb Group and cannot thank them enough for the extra effort and for all our employees here at Point Breeze.