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

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 nurses to serve our patients and clients. Our Case Management team of RNs are credentialed in general case management, maternal and newborn nursing as well as Disease Management This high percentage of professionals speaks to our commitment to provide the finest services to at risk patients.