Case Management.

Case Management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs.  Our program provides:

  • Meaningful case manager interaction
  • Resources and benefit education
  • Health education to influence behavior change
  • Provider and health-care team collaboration
  • High-quality, cost-effective care coordination
  • Direction to in-network providers
  • Pharmacy case management
  • On-site capability

Utilization Management.

Utilization Management is designed to ensure optimal, cost effective outcomes while maintaining a focus on quality care for both inpatient and outpatient services.   We use nationally accepted guidelines in determining medical appropriateness. Continuous monitoring and communication with health care providers allows us to follow the patient throughout the healthcare system and assure that appropriate settings and resources are utilized.

 

Conditions Management.

Our Conditions Management programs promote preventative maintenance for individuals with targeted conditions.  These conditions have potential for progressive increase in healthcare utilization and cost if not managed appropriately. Our program provides: 

  • Identification of members with chronic conditions
  • Disease-specific, evidence-based, interventions
  • High-touch interaction with a health coach
  • Resources and benefit education
  • Health education to influence behavior change
  • Provider collaboration
  • Self-management promotion
  • Pharmacy input and intervention