Case Management

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

Case Management Services work with the most difficult medical cases to review for the appropriateness of treatment plans while striving to improve the quality of patient care and minimizing the cost of the medical treatment. Case managers engage with patients, family members, and all providers in the coordination of services from discharge to additional transition of care settings. Case Managers review alternative options for care and negotiate treatment levels and cost to assure that the patient is getting the right care in the right place for the right cost.

Oncology Case Management

MedWatch aggressively manages patients diagnosed with cancer using a comprehensive and integrated approach. The Oncology Case Management program is managed by clinically experience, degreed RNs who are skilled in managing not only episode of care but the whole care continuum.

Transplant Case Management

MedWatch has a staff with extensive experience in Transplant Case Management. They communicate with providers, patients and family from evaluation through all phases of transplantation care while working closely with the Transplant Coordinators at the facilities. Outcomes resources are researched and Case Mangers assist with referral to the optimal center to meet the patients’ and the plan’s needs.

Maternity Case Management

Our MOM program is embedded in our UM program at no cost. A questionnaire is sent to all known pregnancy cases. Early warning signs and education are addressed for moms-to-be on ways to reduce risk factors for themselves and their unborn child and provides early identification of any unexpected maternal/neonatal admission. An intervention risk assessment is completed. At 20, 28 & 34 weeks, calls are made to the doctor’s office. If during this time any abnormalities are noted, CM is implemented with case being assigned to a CM with obstetrical expertise.

Neonatal and Pediatric Case Management

This Neonatologist supported program addresses the needs of premature babies (approximately 1 in 8) and medically complex newborns requiring special care immediately after birth. MedWatch Case Managers work collaboratively with providers to promote evidence-based decisions and work collaboratively in developing a plan of care specific to the needs of each child. The goal of MedWatch’s neonatal program is to manage these complex cases, decrease neonatal intensive care unit (NICU) days, and coordinate their care needs upon discharge from the hospital and throughout the first year.

Pain Management

Pain is one of the most common reasons people consult a physician, yet frequently it is inappropriately treated. Healthcare costs related to Pain Management have escalated in the past 10 years and resulted in expensive and often unnecessary procedures and the use of addictive medications. Poor oversight has led to opioid dependency issues that have substantial economic and personal costs and most often have negligible, if any, benefit to the member. MedWatch’s Pain Management Program offers early intervention, ongoing monitoring, and patient engagement to avoid these treatment pitfalls. Members are supported throughout the treatment process to provide positive outcomes to the member and the plan.

MedWatch Medication Management

MedWatch’s Medication Management program, overseen by our on-staff PharmD, provides a comprehensive evaluation that helps identify opportunities by reviewing medications, looking for alternative treatment options that can improve member care while providing substantial savings to the plan. Medication adherence, particularly for members with cancer and diabetes, can improve outcomes and help reduce medical spending that results from less than optimal management of these conditions. MedWatch Case Managers explore all options in collaboration with the member’s provider and assist with obtaining the medication and the setup of any infusion needs. Under most prior authorization criteria, clinical information is necessary to verify that a specialty drug is medically appropriate for a patient. By deploying these steps and taking a comprehensive approach to understanding specialty costs, plans can help their members access these important medicines and use them safely and effectively.

Psychiatric and Substance Abuse Case Management

Case management is the coordination of services for mental health and substance abuse patients to assist them, and their families, effectively and efficiently to achieve the most independent and fulfilling lives possible. Individuals that have high utilization of mental health or substance abuse services are at risk for crisis or acute care. Case Managers aid in identifying patient’s needs, goals, strengths/abilities, and preferences in their treatment and recovery. This process is person-centered, resulting in an individualized plan for maintaining the individual’s well-being and for pursuing their stated goals and objectives. The Case Manager will assist the individual with the network of resources that will help maximize functional independence.

Chronic Condition Case Management

70% of disease is preventable, but once an individual has crossed over to a chronic disease 70% of the events that occur due to that disease are preventable. MedWatch’s Total Lifestyle Coaches work individually with members to encourage compliance with their care standard as well as positive lifestyle changes.

Medical Necessity Reviews

Medical Necessity Reviews (MNR) are performed to assist TPAs with claims determinations and adjudication. MNRs may require review by a physician of the same specialty for complex and costly treatments plans to guide medical necessity determinations. Medical Necessity is substantiated and evidenced using nationally accepted guidelines and compendia based evidence for research.

Medical Disclosure for Underwriting

Provides stop loss carriers/MGUs with in depth clinical assessments on individual members for use when making underwriting or renewal decisions. Reports include treatment or surgical plan with medical and Rx cost projections for the next 12 months.

Want to see more?

Use our contact form to request a full Menu of Services from our client services team!