Innovative Care Management’s focus on the early identification of major cost episodes is the unique value proposition that ICM provides to our Self Funded clients. We have tightly integrated our Utilization Management and Case Management teams, which optimizes rapid identification and proactive implementation of Case Management services. This approach provides our Case Managers access to individuals with high risk/high cost diagnosis early and reduces the fragmentation of service delivery, improves outcomes and saves money for the members and plans alike. Many firms rely on claims data for identification for Case Management and often have a high dollar threshold that must be reached prior to assigning a Case Manager; we think this is neither proactive nor nearly as effective. Our extremely proactive approach is a key differentiator in the marketplace.
Utilization and Case Manager nurses evaluate each case on an individual basis. Immediate demonstration of cost savings is not the sole criteria for opening a case, as often occurs in other companies. Quality of care and life issues, as well as identification of the potential for prevention of unnecessary medical usage and costs, receives equal consideration. Proactive Case Management intervention begins as soon as an appropriate case is identified, typically several weeks in advance of any claim dollars being recognized by the TPA.
Innovative Care Management’s philosophy and approach to care management is to provide the best Utilization and Case Management oversight in the industry, while simultaneously minimizing financial risk to our clients. Patient advocacy is key to insuring patient cooperation, compliance, understanding and subsequent outcomes. Improved outcomes from complex medical problems translate into lower health care costs, therefore, the health plan and patient both benefit from case management services.
It is also worth noting that ICM is able to work in an objective fashion when managing care. Many carriers and PPO’s are actively concerned with Provider reimbursement negotiations, and are therefore somewhat beholden to financial concerns of those same doctors and hospitals; ICM feels that our independence allows us to act on behalf of our clients without these ethical “challenges” encumbering our oversight. Fortunately for our clients and Stop Loss partners, this independence allows us to dynamically drive superior clinical and financial outcomes.
Innovative Care Management prepares reports on a quarterly basis summarizing services rendered, outcomes managed, and savings realized. ICM’s quarterly reporting format has been developed with strong input from clients, consultants and partners (customers, TPA’s, Reinsurance Carriers, etc…). The quarterly client report provided by Innovative Care Management provides a savings overview and a summary overview of savings by program. Return on Investment is reported and is based on the Cost Savings over all programs against our invoice.
Hard dollar and cost avoidance savings are denoted by quarter and adverse determinations, plan exclusions, third party liability identification, days reduced, negotiated savings and redirection to preferred providers are all included in our cost savings summary