Member Health Management
A fundamentally different approach to population health.
Connect your teams to a trusted healthcare partner.
Have you ever left the doctor’s office feeling like you had more questions than answers? Were you ever given a diagnosis without a treatment plan? Maybe you didn’t know what to do or where to go next.
You’re not alone. Many people have had trouble navigating the healthcare system. That’s why Premise Health has redesigned primary care to better serve and provide members with meaningful, tailored solutions. We take a proactive approach to helping members, ensuring they receive appropriate, evidence-based treatment plans and hands-on guidance when they need it most. Our providers leverage big data, advanced technology, and innovative partnerships to support and guide people throughout their care journeys, serving as trusted partners and allies along the way.
The result is a different kind of healthcare. Members benefit from seamlessly integrated care – and the peace of mind that comes from having a plan. It’s a powerful approach that leads to better outcomes, lower costs, and exceptional experiences.
The right care when and where you need it.
Collaborating to Enhance Care Delivery
Unnecessarily high costs, poor outcomes and inappropriate care has become status quo in healthcare for both individuals and the companies who insure them. That’s why Premise has redesigned the delivery of primary care. We’ve teamed up with some of the nation’s top innovators, including Mayo Clinic, to increase access to quality care, enhance the member experience, and lower overall healthcare costs.
We’re setting the bar higher in the healthcare industry by helping our members overcome barriers to quality care, such as access, time, and coordination. We’re giving our people the opportunity to benefit from a seamless care experience that is helpful, not a hassle.
U.S. employers spend more than $680 billion annually on wasteful medical spend – a result of unnecessarily high cost care, poor outcomes and inappropriate treatment.
We Know Your Name
We take a holistic approach to helping members manage their care. Our highly skilled providers and care specialists take the time to learn your members’ name while investing in their overall health and wellbeing. We leverage data to identify and engage with members who need our care the most. Our team is then able to close care gaps and make new connections with members so they feel supported throughout their care journey. This ensures members receive appropriate, evidence-based treatment plans and hands-on guidance. With the help of a care specialist, members feel the safety that comes from having a plan, and the confidence that comes with knowing you have a trusted partner to help you succeed.
Roughly 5% of the population drives more than 60% of total healthcare spend. However, only about 30% of high-cost claimants will remain expensive year-over-year.
Second Opinions that Matter
Two heads are better than one – especially when it comes to getting second opinions on complex health conditions. Through our center of excellence collaboration with Mayo Clinic, Premise providers gain access to the highest-quality specialty expertise to ensure members receive the right diagnoses and treatment plans while avoiding unnecessary care.
Approximately 30% of care is unnecessary or ineffective.
Our eConsult program is a digital consultation between a Premise provider and Mayo Clinic specialist about a member’s care. There are many scenarios in which a member may be a good candidate for a second opinion: they have a complex or abnormal diagnosis/test result, is on a treatment plan that is not working, or has been told by a community provider that they need a major surgery. In these critical moments, Premise providers gain access to objective expertise from a Mayo Clinic specialist or subspecialist. Members don’t need to need navigate these decisions on their own, we work with the best and do it for them – saving both time, expense, and ensuring appropriate treatment.
The Right Match – Quality and Cost
Just like you can’t judge a book by its cover, you can’t judge hospitals or specialists by a single achievement. Quality matters, and no hospital is good at everything. The same is true of specialists. The reality is that care facilities and specialists are generally high performing in certain areas, but low performing in others. Further complicating things, prices vary significantly, even in-network. In fact, the decision of where members receive care has a huge impact on price.
The cost of a procedure at a hospital may be five to 10 times more expensive than if it was performed at a surgery center in any given market – a variance driven by care setting, not quality.
This makes navigating care within the community tricky. To solve for this, we take a data-driven approach that identifies and matches members with the highest-quality providers and care facilities. To make things even easier for members, we have a team of care navigators who provide peace of mind and convenience as they coordinate appointments and ensure care runs smoothly before and after each visit. Our team helps find and refer members to high-value, in-network and cost-effective providers and facilities. They make the process simple for members, whether inside our four walls or in the community.
Seamless Support for Complex Care Needs
If you or a loved one have ever been diagnosed with a complex, serious or rare condition, or were told you need a high-cost, high-risk treatment, you know that it can be overwhelming and often difficult to navigate the right course of action. At Premise, members are never alone when it comes to making complicated decisions about their health. We’ve teamed up with Mayo Clinic to create a center of excellence program that provides streamlined, managed access to Mayo Clinic for members with high-cost and high-risk diagnoses, or for those who have been unable to find answers elsewhere. By leveraging Mayo Clinic’s Complex Care and Care Pathways programs, we are able to offer expedited access to the highest quality care in the nation, ensuring smooth transitions as well as rapid evaluation, accurate diagnosis and appropriate treatment for members who need it most.
Medical error is the third leading cause of death in America.
Our Member Health Management solution includes:
- Holistic care management
- Downstream care navigation
- Second opinions
- Centers of excellence