CASE MANAGEMENT

Active care coordination focused on improving patient's outcomes, and patient satisfaction while maximizing cost containment and financial oversight.

MedWatch…AN EXPERT TEAM OF CLINICIANS MANAGING CLINICAL RISK ACROSS THE HEALTHCARE SPECTRUM…

Components of MedWatch Case Management:

• Medical necessity determination
• Care plan development
• Discharge planning
• Case cost estimates/ financial profiling
• Network steerage/care resources identification
• Provider negotiations
• Assisting patient/family with education and appropriate medical care decisions
• Pharmaceutical management
• Physician advisor panel
• Quality of care assessments
• Review of cases for audit/cost reduction opportunities
• Comprehensive reporting including savings
• Qualified and objective stop-loss consulting
• Defensible ROI
• Specialty Case Management: Kidney Care, Cancer Care, Transplant Management

The following cases are automatically flagged for free Case Management screening:

• Trigger diagnosis list/high risk cases
• 5 day length of stay
• Repeated hospital admissions
• High dollar, or potential high dollar cases
• Biopsy reviews/confirmed pathology findings

Cases may also referred to MedWatch CM by:

• TPAs – per claims data or case history
• Data Mining/Warehouse sources
• Stop loss carriers
• PBM claims data
• Alerts from PBMs, EAPs, Wellness vendors