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Pathway Review Systems, Inc.

Health Awareness Program (HAP)

The Pathway Review Systems Health Awareness Program takes case management to the next generation. This program is designed to assist and manage those members with targeted risk factors and chronic conditions, which may potentially lead to a higher than average claim incurrence. Based on a predetermined list of targeted risk factors and targeted diseases, the Pathway Review Systems disease management professionals will use a variety of intake methods to identify candidates for the Health Awareness Program. These intake methods can range from referrals from internal utilization and case management staff, to completion of a health questionnaire by plan participants during open enrollment, to analyzing both pharmacy and medical claims data through a data mining system.

Targeted diseases are as follows:

More information 

  • Arthritis
  • Asthma
  • Chronic Obstructive Pulmonary Disease
  • Congestive Heart Failure
  • Coronary Heart Disease
  • Diabetes I and II
  • High Blood Pressure
  • High Cholesterol
  • High Risk Conditions

Once a participant has been determined to possibly be a candidate for health awareness services, they are contacted telephonically by an RN level disease manager for a comprehensive and disease specific assessment. Based on the outcome of the assessments, the participant is triaged to the appropriate health awareness level based on acuity. With that, a personalized care plan is developed, along with the appropriate levels of ongoing telephonic education and monitoring to ensure care plan compliance.

Right of Change

Pathway Review Systems reserves the right to modify the parameters of the services listed above without notice when clinically and/or operationally necessary/warranted. Provision of any services not listed above may be subject to additional fees.