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Care and Cost Management

INETICARE’s Care Management suite of services advocates wellness, prevention of uncontrolled disease states, and, in the event of a need for healthcare intervention, the provision of only the highest quality care–improving ease of access to and appropriate utilization of a highly-skilled continuum of healthcare provider partners.

INETICARE is the care management division of INETICO that consists of Registered Nurses, credentialed and URAC-accredited Physician Advisors, and a Board-Certified Medical Director.  INETICARE’s care management suite of services advocates wellness, prevention of uncontrolled disease states, and, in the event of a need for healthcare intervention, the provision of only the highest quality care–improving ease of access to and appropriate utilization of a highly-skilled continuum of healthcare provider partners.

WHY IMPLEMENT AN INETICARE CASE MANAGEMENT PROGRAM?

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
INETICARE'S Case Management Program in conjunction with Utilization Management and Disease Management providing a sentinel role can result in claims savings of from 8-18.2% on average. 

An anticipated ROI for our Case Management Program could range from 8-12 dollars for every dollar spent.  Of course some cases will have more and some less, depending on the specifics of the case.

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.

INETICARE's suite of services encompass all areas of care management including :

  • Utilization Management
  • Case Management
  • Disease Management
  • Maternity Management
  • Clinical Data Mining

VALUE ADDED SERVICES

  • Online Pre-Certification
  • Online Medical Library
  • Online Referrals
  • Online Reports

INETICARE's Utilization Management encompasses the following specialties:

  • Hospital Inpatient and Outpatient Procedure
  • Precertification
  • Prospective review
  • Retrospective review
  • Concurrent review
  • Proactive Treatment & Discharge Planning Assistance
  • Specialty Peer Review
  • Medical Record and Claim Review
  • Online, real time reporting

Utilization management encompasses many aspects of evaluating the plan member care while balancing the plan administration.  With the assistance of the INETICARE Nurse, companies can better manage costs and improve clinical outcomes.

INETICARE'S Case and Disease Management Programs

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.

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.

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

INETICARE'S MATERNITY MANAGEMENT PROGRAM

H.U.G.S. is a retention and loyalty-focused maternity management program designed to promote maternal and fetal health while helping the organization reduce costs by providing meaningful employee support. H.U.G.S. helps an expectant mother get appropriate prenatal care, follow her doctor or
midwife’s direction and seek care when it is most effective. As a result, H.U.G.S. can help keep your group’s claims experience down.

Studies show an ROI of $4.75 for every dollar spent on prenatal care when utilizing a maternity management program.

CLINICAL CLAIMS DATA MINING

  • Review of UM, CM, DM, Pharmaceutical and Claims Data
  • Recommendations based on data interpretation & trending
  • Plan design and underwriting assistance
  • Assistance withWellness and Employee Health Education
  • Clinical Benchmarking