Preauthorization & Utilization Management

Our Preauthorization & Utilization Management program provides the foundation for ICM's ability to identify, manage and mitigate clinical episodes within the Self Funded programs we manage. Developed in 1993, this program enables us to ascertain the medical necessity of the services a patient may receive, ensure that the treatment is the most appropriate and cost effective, and most importantly, allow our team to identify high risk and high cost patients early on.

Cost Savings

Through our Preauthorization & Utilization Management program, we are able to provide significant savings by promoting the following interventions:

  • Redirection into PPO
  • Negotiating with vendors
  • Avoidance of unnecessary hospital stays
  • Appropriate and Timely Discharge Planning through concurrent review
  • Denial of requested services if they are not medically necessary or are a plan exclusion

Program Description

Our standard Utilization Review services include the following core deliverables:

  • Preauthorization for inpatient and outpatient surgery
  • Vendor negotiations
  • Mental health and chemical dependency review
  • Concurrent review
  • Discharge planning
  • Home healthcare review
  • Skilled nursing review
  • Case management referral
  • Reconsiderations and appeals
  • Redirection into PPO
  • Second Surgical Opinion

How it works: Whenever a patient needs a high cost service, the provider calls ICM. Our Preauthorization Staff then enters the patient's demographics, and verifies that the procedure requires preauthorization according to the customizable parameters set by our client. If the procedure requires preauthorization, the Preauthorization Specialist enters the medical information, verifies that PPO providers are being utilized, and, if possible, authorizes the procedure over the phone. If the procedure is more complex, the Preauthorization Specialist will request clinical notes to go to a Utilization Management RN. Our Utilization Management Nurses use nationally published criteria to determine if the procedure is medically necessary and appropriate based on the information provided. If the procedure is questionable or complex, the information is then forwarded to the Medical Director for a final determination.

Additionally, hospitalized patients are concurrently reviewed via telephone throughout their stay. On-site concurrent review may be done in cases where significantly complex medical care is occurring and complex discharge planning needs are identified.

With an average turn around time of 3.5 hours, our team of trained specialists and certified nurses is able to quickly and effectively make these determinations, without hindering the care of the patient. Compared to the Department of Labor regulation requiring a determination in 15 days, Innovative Care Management stands out for our speed and efficiency. We are extremely well known and respected by Medical Providers and Hospitals as an efficient, friendly, and professional organization; this respect promotes a collaborative, rather than confrontational, oversight of our mutual members' care.

The Preauthorization & Utilization Management Team

At Innovative Care Management, we pride ourselves on superior customer service, efficiency, quick turn-around time, and accuracy in our determinations; none of this could be done without the two departments of this program. The Utilization Management Department consists of 9 RNs, all with CPUR certification, including a supervisor of the department to oversee the process. Also, the 8 members of our Precertification department undergo extensive training in customer service, medical terminology, and our proprietary database. Additionally, the department supervisor reviews all pre-authorizations, every day, to assure that the highest care and attention are given throughout the process.

Case Management

When it comes to healthcare management, it's important to keep in mind that 20% of your enrollees account for 80% of your overall costs. 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 timely and appropriate care for seriously ill patients. Through this program, our Nurse Case Managers are able to reduce costs, 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 our patients receive 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 alternatively receive home health or hospice services in the comfort of his/her own home. At the same time, the employer is not paying for an expensive and unnecessary hospital stay. The following tools and strategies are frequently utilized in our Case Management oversight, leading to significant cost savings for our members and plans alike.

  • Redirection into PPO
  • Negotiation with vendors
  • Discharge planning through concurrent review
  • Denial of requested services if they are not medically necessary or are a plan exclusion
  • Cost avoidance and prevention of unnecessary services or hospital stays
  • Direction of services to most appropriate, least costly alternative

Program Description

Patients are first identified by our Preauthorization and Utilization Management departments. If a patient looks to have a potentially high risk situation, the Case Management department is immediately notified. Sometimes, the TPA or the Employer may notify us of potentially high risk patients that they have identified through other means. At this point, a dedicated and highly trained Case Manager is assigned to the patient, with primary responsibility in monitoring patient care and status. A variety of illnesses and complications are covered under ICM's Case Management program, including:

  • Cancer
  • Congestive Heart Failure
  • Traumatic injuries
  • Organ failure
  • Transplants
  • High-risk pregnancy
  • Complex medical diagnoses
  • Complex psychological issues

Once a patient is actively case managed, the Nurse Case Manager works closely with the patient, along with 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 simultaneously promote a high standard of care and significant cost savings to the member and plan.

  • Early identification through Utilization Management
  • Identification of preventative services
  • Patient stabilization
  • Coordination of care with all caregivers
  • Patient advocacy
  • 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 of RNs (2 of whom have RNC certification in maternal, and newborn nursing, 2 more of whom are credentialed in Disease Management, and 80% of whom have CCM certification) compose approximately 40% of our company. This high percentage of professionals speaks to our commitment to provide the finest services to at risk patients. 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.

Healthy Mother Baby

Giving birth to a baby can be one of life's most exciting experiences. However, this experience also has the potential to become a Self Funded plan's largest single cost: the birth of a premature infant. With this in mind, Innovative Care Management developed its Healthy Mother Baby Program in 1992 to promote a healthy and active attitude among pregnant enrollees. With a combination of personal contact from a highly-trained nurse and educational support materials, our Healthy Mother Baby Program is able to encourage expectant mothers to take the necessary steps to promote the likelihood of delivering a healthy baby.

Cost Savings

At a cost frequently in excess of $300,000 per occurrence, the birth of a premature infant is a serious consideration for Self Funded plans and Stop Loss carriers alike. With the Healthy Mother Baby Program, a proactive option is available to minimize this risk, while at the same time providing an extremely useful and appreciated resource for members. Compared to the CDC national average statistics on Premature Deliveries, Innovative Care Management's HMB program stands out in its ability to reduce the financial risk to our clients.

Program Description

Potential participants for this program are identified through a variety of sources: communication pieces promoting the program, maternity-related claims received by the claims administrator, or sometimes through information taken by our Preauthorization Staff. If the patient is between 12 and 28 weeks of pregnancy, the expectant mother is contacted by one of our Perinatal Nurse Case Managers, given some information regarding the program, and asked if she would like to enroll. Once enrolled, expectant mothers are monitored during their pregnancy and after delivery to ensure that they and their child receive the services they need for a successful outcome. While our focus is on educating the expectant mother, we may also coordinate services with the patient's physician. Enrollment in the program entitles the mother to receive a number of services and materials, including:

  • Risk level determination through early screening
  • Monthly nurse contact with patient
  • Counseling and pregnancy education
  • Educational Materials
  • Free Video & Book Library
  • Follow-up contact regarding breast feeding, well baby, and preventative care

Many of our plans provide incentives for the mother to participate in the program, which has been found to be a most effective tool in boosting enrollment. Typically, a gift certificate is mailed to the mother at the end of her pregnancy, which often goes toward the purchase of a car seat or other necessary item for the newborn. Alternative incentives include giving a savings bond in the child's name and/or paying for the childbirth class expenses. Innovative Care Management typically administrates whatever incentive the employer chooses, and the employer is subsequently billed for the additional cost of these incentives.

The Healthy Mother Baby Team

Our Healthy Mother Baby Program aims to ensure that expectant mothers have the best information and advice available, and to that end, Innovative Care Management currently has 2 RNCs, certified registered nurses specializing in maternal and newborn health, running the program. With the aid of a dedicated Healthy Mother Baby Assistant, our team is able to provide efficient, quality care to our maternity patients.

Disease Management

The Disease Management Program is designed to provide your enrollees and you with supplementary
information and educational resources on how to care for themselves when  dealing with a chronic medical condition. An Innovative Care Management (ICM) nurse works closely with the individual, the family, and their physicians to ensure that they have the information and support that they need to effectively manage their chronic medical condition.

Cost Savings

The most recent statistics indicate that the average person spends $6,280 on healthcare per year. Those with chronic diseases spend 7 times this amount every year, which is nearly $44,000 per person per year. More effective self management skills significantly impact these costs.
Program Description

The ICM Nurse provides comprehensive individualized education and instruction to employees with any of the following conditions: asthma, heart disease, heart failure, diabetes, and/or emphysema. The goal is to promote enhanced employee self care.

Medical Director Services

In a field such as medical management, it is very important to constantly ensure that our members' care is never compromised. It is our role to assure that the care proposed is appropriate, timely, and covered by the plan we are working for. It is precisely for this purpose that Innovative Care Management includes Medical Director Services as an adjunct to all of our programs. ICM's Medical Director is a board certified physician who can provide objective determinations of medical necessity, clinical oversight, and frequently assists in the development of our clients' plan wording and policies.

Program Description

The Medical Director is an essential component to all of Innovative Care Management's services, and plays in active part in our decision making process. In the interest of providing only the best in medical management, the Medical Director provides such services as:

  • Medical Necessity Determinations - When a procedure is complex or questionable, the clinical information is forwarded to the Medical Director for final determination to be certain that the review is done with the highest care and analysis.
  • Denial Determinations - Whenever one of our nurses believes that a procedure should be denied for clinical reasons, the review is forwarded to the Medical Director to make the determination.
  • Clinical Oversight Committee - Our Medical Director heads the clinical oversight committee where we routinely streamline our reviews with the most up-to-date information in our decisions.
  • Quality Assurance - As a standard procedure, the Medical Director reviews a random selection of procedures authorized through our Utilization Management and Case Management departments to verify that consistency is maintained between the Medical Director and our nurses.
  • Appeals - When a denied procedure is appealed, the Medical Director oversees the appeals process, and reviews any additional information that is provided.
  • New Technology Research - In cases where new or experimental procedures or technology are requested, the Medical Director will research information and determine if it is medically appropriate and covered under the benefit plan.

Pharmacy Review

Not all high-risk and high-cost patients have costly procedures that would typically alert us to their need for Case Management oversight. Our Pharmacy Review program was designed as an alternate method of detecting patients with chronic conditions that would benefit from our Case Management and/or Disease Management programs. Additionally, the program provides a method of:

  • Enhancing physician coordination
  • Identifying possible drug interactions
  • Detecting patients who may be misusing drugs
  • Detecting patients who may be overusing drugs
  • Coordinating benefits
  • Coordinating patient care
  • Identifying less costly drug alternatives

Cost Savings

Our ability to detect patients with chronic conditions through clinical and pharmaceutical identification allows us to encourage the patient in caring for their condition properly, with the end result being fewer hospitalizations and high cost treatments. Our approach is to ensure that appropriate preventative measures are being taken, rather than far more expensive reactive measures. Additionally, our ability to detect misuse of certain drugs and coordinate physician interaction allows us to identify such cases and control the problems they cause. For instance, if a patient is receiving multiple prescriptions from a variety of physicians that may overlap or even conflict with each other, we contact the prescribing physicians and promote that the patient receives the necessary medications from only one prescribing physician. Or, if a patient has a high usage of narcotics, we have the ability to do a tablet count and determine if a better alternative exists for the patient, at the same time reducing the number of prescriptions the patient is receiving.

Program Description

Every month, we receive a report from the client’s Pharmacy Benefit Manager (PBM), and from the data, we identify the patients based on a variety of parameters. Based on this data, we sort which patients are potentially high risk patients, get claims data from the TPA, and a complete list of prescription information from the PBM. From this data, we are able to determine which patients would benefit from Case Management or Disease Management, and are also able to determine if there are any red flags regarding drug usage, eligibility, or incorrect billing. Implementation of this program requires extensive collaboration with the employer's pharmacy benefit manager (PBM). Currently, ICM has established relationships with multiple PBMs where we can easily retrieve data from existing report databases at no extra cost. We are also able to work with new PBMs to establish a similar relationship. The fee for this program covers the compilation and analysis of reports from the vendor. Patients identified through this mechanism are referred to the Case Management or Disease Management programs to facilitate the appropriate treatment plan and manage costs.

24x7 Nurse Line

Immediate professional assistance and advice for medical questions and concerns available 24 hours a day, 7 days a week.

Cost savings

Designed to assist enrollees in making appropriate decisions regarding seeking emergency care and proactively identify enrollees who may need case management services.

Program description

  1. Toll free phone access
  2. Registered nurses available 24 hours a day, 365 days a year
  3. Bi-lingual representatives with 150 additional languages served
  4. Health information sheets available via fax, mail or email
  5. Follow up calls within 24 hours to any member referred to emergency room, urgent care, or immediate physician referral
  6. Follow up calls within one week to members receiving health information sheets
  7. Referral to other ICM programs
  8. Quarterly reporting