Case Management (CM) & Disease Management (DM)
The INETICARE program consists of a team of Registered Nurses dedicated to improving the quality care of plan members while controlling costs.
Why Implement Care Management Programs?
- Reduction in claims expenditures for those members actively case managed
- Overall reduction in plan medical costs Reduction in lost time from work for active employees.
- Improved member education resulting in better self-management.
- Improvements in quality of life for those individuals in case management
Disease Management Program can produce a savings of between 2.2% and 8% over a three year timeframe.
Managing the disease in a DM program can prevent catastrophic occurrences and/or identify cases requiring the higher level of intervention provided by Case Management. Early referral to Case Management through UM and DM processes ensures that health decompensation is dealt with swiftly thus minimizing financial impact.
Services generally included in care management and case management include:
- Telephonic and/or Onsite/Field
- Catastrophic, Crisis & Chronic Disease Management
- Life Care Needs Assessment and Planning
- Online password-protected case notes
- Patient direction to appropriate preferred providers
- Online referral service
- Data and Negotiation Integration with Claims
- Online reporting
- 24/7 Nurse Care Management
The effectiveness of Case Management and Disease Management are linked to our Health Data Analysis, as well as, our ability to put in place ongoing triggering mechanisms that identify patients who would benefit from Care Management.
Through our Case Management Department, we systematically and proactively identify high-risk patients and assess opportunities to coordinate and manage total care. Medical, psychosocial, cultural, nutritional, spiritual, and personal needs of the individual are addressed especially those who are at high risk for complications related to chronic disease. Key case management responsibilities include assessment, problem identification, outcome identification, as well as planning, monitoring, and evaluating case management interventions. The Case Manager becomes a facilitator, coordinator, counselor, and patient advocate to ensure that the best quality of care available is delivered to individual patients in the most efficient and effective manner possible.