Balancing Patient Care and Cost-Effectiveness
MedCost’s Complex Case Management program offers special intervention when certain cancers, strokes, or serious injuries or illness occur. These life-altering events make up about 20% of all hospital admissions—and about 80% of the costs. Case Management yields significant savings and promotes quality of life outcomes by focusing on early intervention, complex care management coordination, patient advocacy and communication, and resource management, with the goal of balancing patient care and cost-effectiveness.
Case Managers Help Manage The Treatment Process
Our case managers are experienced, registered nurses who have the Certified Case Manager (CCM) designation. This specialized training enables them to arrange patient care and negotiate cost-effective rates for services, therapies, and equipment if an in-network source isn’t available. Case Managers work with the patient/caregiver, physician, and claim administrator to complement a doctor’s prescribed plan of care and make the most efficient use of health plan benefits over the course of long-term treatment. In addition, case managers encourage members to apply for special benefits, if applicable, such as long-term disability; assist members in finding and obtaining community services; and provide education on topics such as managing pain, proper nutrition, and possible medication side effects or interactions.
Specialty Case Management For The Costliest Types Of Cases
MedCost provides specialty case management services as part of our Complex Case Management program at no additional charge
. Specialty case managers are registered nurses with clinical experience in their areas of specialty who have the CCM designation. They work closely with Centers of Excellence (COE) programs and guide members to appropriate facilities, when necessary, based on favorable health outcomes and lower claim costs.
The specialty case managers focus exclusively on:
- Transplant – work with members requiring solid organ and bone marrow transplants; educate the member on how to evaluate the quality and cost associated with available COE for their condition and treatment
- Dialysis – review the member’s current care plan; educate on the benefits of staying in network and assist with selection of appropriate provider; review health benefits, including education on the benefits of enrolling in Medicare B
- Oncology – research clinical trials to ensure recommended treatment is appropriate and covered under the member’s health plan, provide guidance, insight, and education on how to navigate the complex care associated with a cancer diagnosis and assist the member with knowing what questions to ask
- Rehabilitation – work with members suffering from spinal cord injuries, strokes and traumatic brain injuries who are admitted to acute rehabilitation, long-term acute care and skilled nursing facilities
- High-Risk Maternity – provide prenatal education and one-on-one mentoring for expectant mothers who have been identified as having risk factors to help ensure the healthiest possible outcome for both mother and baby