A software-based, integrated member decision support system provides a
method for corporations, insurance carriers, health maintenance
organizations, physicians, physician groups, or other clients to
efficiently provide medical, pharmaceutical, and health benefit advice
and information for an enrolled population. The system contains one or
more databases which include member profiles, clinical information and
guidelines, pharmaceutical information and guidelines, health benefit
information, and optional additional information. A caller establishes
communication with the system, which directs the caller to an operator
who provides the caller with medical, pharmaceutical, and/or health
benefit advice based on an inquiry from the caller and the information
stored on the system. The system may automatically alert the caller or
the operator of important medical or pharmaceutical information. At the
conclusion of the call, the system or the system with the operator's
input, may update the caller's member profile, request written materials,
generate referrals, order prescriptions, or generate reports.