Care Management Solutions

Integrate and analyze all member health information in one place, with our help. Our customized population management solutions monitor and measure healthcare trends, costs and quality across the continuum of healthcare, providing a “whole person” view that helps you manage your care plan more effectively.

Care Management identifies and manages the real driver behind the rising cost of healthcare – the two percent of the population that generates 40 percent of the cost. Our URAC-accredited care management team, in conjunction with our registered nurses, provides better care and after-care follow-up to reduce risk and help reduce the episode of care costs.

Care Management Benefits

  • Interfaces with reinsurance vendors
  • Coordinates specialty pharmacy program needs for patients
  • Reduces episode of care costs

Care Management Features

  • Assesses patient’s needs and then plans, coordinates and monitors services to ensure smooth, effective care and recovery
  • Manages activities with providers and care programs, including second opinions and transplant networks
  • Keeps communication channels open between patient (and family) and doctor, employer, insurance companies and benefits managers

Condition (Disease) Management

By coordinating health and benefit management, our URAC-accredited team promotes early intervention and can decrease the long-term cost of disease care. Health analytics can even provide predictive modeling for individuals with chronic or mid-term health conditions.

Disease Management Benefits

  • Decreases the long-term cost of diseases
  • Promotes early intervention, self-management and compliance with treatment plans
  • Provides education, support and referrals

Disease Management Features

  • Registered nurses and physicians review the medical and pharmacy claims of those who may benefit from Condition Management. Modules include:
    • Asthma
    • Chronic obstructive pulmonary disease
    • Congestive heart failure
    • Coronary artery disease
    • Degenerative joint disease
    • Diabetes
    • Gastric reflux
    • Hypertension
    • Low back pain
    • Obesity
    • Pregnancy

Absence Management

Four percent of the average payroll can be attributed to unscheduled absences.

Our registered nurses help manage unscheduled absences, patterned short-term illness, short-term disability, long-term disability and workers compensation to maximize your company’s productivity and profitability.

Absence Management Benefits

  • Promotes early intervention and management of health and disability claims and trends
  • Improves productivity
  • Coordinates and outsources services for difficult cases
  • Provides the clinical expertise to understand absence issues

Absence Management Features

  • Proactive assessment, benchmarking and management of employees’ unscheduled work absences
  • Includes short-term disability, long-term disability, FMLA and workers compensation incidences and claims