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Disease Incidence

The Disease Incidence Model® is a revolutionary software tool developed by Strategic Health Resources® in conjunction with Milliman & Robertson, Inc. to identify the disease burden of any population.

The Disease Incidence Model®

  • • Predicts the incidence of disease for any population of members,
    • Benchmarks the predicted incidence against national standards, and
    • Identifies outliers from a disease frequency and a cost perspective.

Diseases are categorized by three-digit ICD-9 code. The only required input to the model is the age and gender distribution of any population.

The Disease Incidence Model® goes beyond traditional underwriting approaches to pinpoint the diseases that result in medical costs. For each population, the Disease Incidence Model® produces a report showing the overall incidence of disease compared to the national norm and quantifying the cost impact of each disease on a per member per month basis and in total. Reports identify diseases that are over-represented and under-represented in the population in terms of frequency and in terms of cost. Reports also depict differences in population demographics driving these variances.

The Disease Incidence Model® provides information to:

  • Avoid Contract Disasters. Identifies adverse selection in covered populations and enables Medical Directors to assess the strength or weakness of provider networks in handling the expected disease patterns in a proposed population;

  • Reduce Medical Costs. Focuses disease management, case management and prevention efforts where they can produce the greatest return;

  • Win Contracts. Distinguishes bids for major employer contracts by giving employers information on their employee population and tailoring disease management initiatives and other programs to meet their specific needs;

  • Support Providers. Assists medical groups and hospitals by identifying and assisting with key medical issues in their member populations;

  • Simplify Compliance. Complies with NCQA and employer coalition mandates for risk assessment;

    Strengthen Provider Networks and Medical Management. Plans for appropriate physician and professional staffing based on the disease patterns of the plan's unique population of patients. Assess regional variations and allocate resources for maximum benefit.

For organizations with adequate data on diagnoses, a more detailed version of the Disease Incidence Model® is available to analyze a population's actual disease incidence compared to our base model predictions and the national benchmark data. It enables users to distinguish cost variances due to adverse selection from those attributable to suboptimal medical management.

Other customized approaches are available, targeted to an organization's particular needs.

For more information or to order a sample report, call Strategic Health Resources at (818) 952-5130.


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