Program Objective
When it comes to healthcare management, it's important to
keep in mind that 20% of your enrollees account for 80% of
your cost. Innovative Care Management's Case Management Program
was designed in 1990 specifically to mitigate the financial
burden of these high cost patients, while at the same time
maintaining a high level of care. Through this program, our
Nurse Case Managers are able to reduce cost, help the patient
receive the best possible care, and maintain a personal and
caring approach all at the same time.
Cost Savings
Through focused and attentive management, our Nurse Case Managers
strive to ensure that the patient receives the highest quality
services, which in the long run prove to be the most cost effective
as well. As an example, a patient with terminal cancer who
would have otherwise been hospitalized, may instead receive
home health or hospice services in the comfort of the patient's
own home. At the same time, the employer is not paying for
an expensive and unnecessary hospital stay. This is just one
illustration of the following tools and strategies utilized
in our Case Management Program to provide significant cost
savings.
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Redirection into PPO
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Negotiation with vendors
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Discharge planning through concurrent
review
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Denial of requested services if they are not medically
necessary or are a plan exclusion
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Cost avoidance and prevention
of unnecessary services or hospital stays
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Direction of services
to least costly alternative
Program Description
Patients are first screened through our Preauthorization and
Utilization Management departments. If a patient looks to be
a potentially high risk patient, the Case Management department
is notified. Additionally, the Claims Payor or the Employer
may notify us of potentially high risk patients. At this point,
a Case Manager is assigned to the patient to monitor activity
and contact the patient. If the patient meets criteria, then
they are opened to active case management. A variety of illnesses
and complications are covered under this program, including:
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Complex medical diagnoses
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Complex psychological issues
Once the patient is actively case managed, the Nurse Case
Manager works closely with the patient, and the patient's family,
providers, and benefit plan to ensure that the patient receives
appropriate care and takes preventative measures to avoid higher
cost services. Through the use of the following proactive measures,
we are able to maintain a high standard of care, and simultaneously
present significant cost savings.
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Early identification through Utilization Management
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Identification of preventative services
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Coordination of care with all
caregivers
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Stop loss notifications to client-specified
parties
The Case Management Team
At Innovative Care Management, we hire the most experienced
employees to serve our patients and clients. Our Case Management
team currently has 2 supervisors, 12 RNs, 2 of whom have RNC
certification in maternal and newborn nursing, and 7 of whom
have CCM certification. Additionally, there are 3 Case Management
Assistants, with a minimum of 6 months experience in our Preauthorization
Department, who are trained to handle the specific needs of
our Case Managers.
Contact Us
Call Innovative Care Management to ask our sales department
about Case Management Program or our other programs. We're
here to help you start saving while maintaining the highest
quality care.
General Contact Information:
Innovative Care Management, Inc.
10117 SE Sunnyside Rd., Box F409
Clackamas, OR 97015
Toll Free: 800-862-3338
Portland Area: 503-654-9447
Fax: 503-654-8570
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