MedCom Care Management's Case Management program provides additional services to manage high dollar cases and minimize future large claim expenditures related to catastrophic illness, injury or chronic disease. Our program stresses personal contact with patients, employers and providers. The Case Manager serves as the patient's advocate by facilitating a comprehensive individualized care plan to address medical, psychological, social and environmental needs.

Objectives:

• Negotiates with out-of-network providers to help limit and reduce participant and plan exposure to excessive charges
• Facilitates the discharge process to assist the participant and family throughout the continuum of care
• Identify those individuals who have experienced, or who are at risk for, a catastrophic illness or injury within a population
• Encourage appropriate use of healthcare services
• Improve quality of care and ensure access to care
• Maintain cost-effectiveness

The integration of information between Gilsbar and MedCom Care Management allows for early identification of cases that need referral into the Case Management program. The following parties work together to coordinate referrals:

• Utilization Management and Review
• Claims
• Client
• Broker
• Other Gilsbar departments
• Patient/Family
• Providers

Through inclusive triggers and diagnosis lists, MedCom's intervention can help save the participant and the health plan money.

• Complex diagnoses
• Coordination of disciplines of care
• Complex psychosocial intervention
• Potential or actual high cost or financial risk
• Increased utilization of inpatient or emergency room care
• Selected diagnoses

For more information on MedCom Care Management and the Case Management program, call 800-643-4416 or contact us today.