Health Risk Assessment
- Participating Physician Groups (PPG)
Health Net performs aggressive outreach to newly enrolled members to complete the health risk assessment (HRA) within 90 days after the effective date of enrollment and annually, depending on specific program requirements. This enables the Health Net care management team to begin managing potentially high-risk members.
The care manager reaches out to the member, further assesses care needs and enrolls the member in the case management program as indicated. Note: All SNP and Cal MediConnect members are assigned a case manager. The care manager collaborates with the member, using the HRA, to develop the care plan. Additionally, the HRA assists the primary care physician (PCP) in identifying and intervening to meet care needs. For other Medicare Advantage members, the completed HRA identifies high-risk members who would benefit from care management interventions.
The HRA completion assists in predicting future consumption of medical care and is imperative to the success of the care management program for both the participating physician group (PPG) and Health Net. With early identification of member needs, resources may be directed to those members at greater risk for poor health. Certain factors, such as chronic health problems, lifestyle risks, family health, and quality-of-life considerations, influence medical care. Parallel analysis of prospective, concurrent and retrospective data sets allows the care management team to provide members with their best efforts to reach and maintain the best possible health status given the member's condition. 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. Educated members require fewer visits and interventions from providers and staff. In addition, informed members have better treatment outcomes and faster recovery times.