Targeting and Clinical Data Analysis

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)

Initial identification of high-risk members is accomplished prospectively using health risk assessments, concurrently through Health Net's online databases of diagnostic information, and retrospectively based on medical and pharmacy claims and other data.

With early identification of potentially high-risk members, resources may be directed to those members at greater risk for poor health and higher costs. Certain factors, such as chronic health problems, lifestyle risks, family health, and quality-of-life considerations, influence medical care use. The Health Net care management program helps the member become a better-educated health care consumer and supports the provider by supplying vital information regarding the member and the member's care.