Health Insurance Companies in the US use Decision Management Services for their Wellness Program

We are increasingly getting older – I don’t tell you something new.

Our complete health care system is in question and gradually being unaffordable – I don’t tell you something new.

We spend the biggest chunk of our health budget during the last years of our life, at times when we actually need care. And that would have to change radically, namely by investing more in prevention, to keep us healthy longer – and now I tell you something fairly new.

This is mainly beneficial to all parties – mutual insurance companies, insurance companies,
employers, government, … – and not least to ourselves also.

Some American health insurance have worked out a Wellness Program that they sell to their client companies. The aim is to motivate the employees of those companies to ‘behave’, at least in terms of health, and to reward them effectively in case of good results. Remuneration can be salary bonuses, or gift certificates, or other benefits, chosen by the company itself.

We can speak of a win-win-win situation:

  • win for the insurance company: reducing the number of submitted claims and so reduce the amount of payouts
  • win for businesses: exercise has a positive effect on the general welfare and health, and healthy employees perform better
  • win for employees: an increase in their quality of life

How does it work:

  • capture of the population at risk
  • determine recommendations for a particular profile, change behavior and learning how to persevere
  • monitoring activities
  • remuneration is based on activities performed and results

In all phases Decision Management Services are used. After all, this is a typical situation of much data available on various systems, elaborate decision trees, need for consistent decisions, not to mention flexibility in the decision criteria.

This flexibility is extremely important. After all, every wellness plan for each new business that the program supports must be unique. Also, the programs should easibly be adjustable after each evaluation back.

Only by pulling the Business Logic out of the rest of the program code such flexibility can be achieved by shorter deployment cycles.

2017-06-19T14:23:28+00:00 October 28th, 2014|Blog|
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