CASE MANAGEMENT

HealthSmart's Case Management program provides a comprehensive approach to managing health care costs and care coordination for members. While 10% of employees account for 70% of healthcare costs in a group, 1% consume 30% of total expenditures. Early access to Case Management services can provide members with education and support to maintain and enhance their level of wellness and quality of life. Our Case Managers are experienced Registered Nurses who provide the following services for members:

  • comprehensive needs assessments
  • health risk assessments
  • care coordination
  • access to community resources
  • coordination of alternative care settings
  • disease specific education

Case Managers have at least 5 years of clinical experience as well as a comprehensive knowledge of managed care. This combination allows them to interact between the patient and payor. To meet quality and cost containment goals, our Case Managers provide the payor with the following benefits:

  • early notification of catastrophic or chronic illnesses
  • early implementation of case management services
  • direction to in-network providers
  • detailed monthly reports
  • cost containment
  • out-of-network negotiation

Case Management referrals are generated from a variety of reporting mechanisms:

  • utilization review data
  • trigger diagnosis
  • complicated readmissions
  • claims data
  • payor request
  • bi-weekly Medical Director case review