As with other healthcare services, consultations in American Well™ should be grounded in evidence-based medicine. In order to ensure that plan members appropriately utilize online healthcare services, American Well includes a customizable business-rules engine that dynamically matches the health plan's financial contribution for a consultation with the appropriateness of the consumer's request. This system allows consumers to receive appropriate levels of care, as determined on an individual basis.
If a health plan identifies a consumer that requires more coordination, it can dynamically and automatically increase its contribution, encouraging the member to speak with a provider who can address the concerns identified by the rules engine. Alternatively, if a member consumes a large amount of discretionary care that is not evidence-based, the health plan can dynamically cap its contribution. The patient can still consume these discretionary services at a higher co-payment rate.
The payment portion contributed by the health plan per transaction is dynamically set by customized business rules. These rules are determined by the health plan, and can be dynamically adjusted to change or eliminate financial participation based on measurements of appropriateness and utilization. This allows health plans to ensure that their contribution for each consultation is based on appropriateness, benefit allotment, and evidence-based medicine.
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