Medical Management
Our medical management services minimize plan spend by addressing the health of employee populations. Prime Dx, our sister company, offers a variety of health services, including disease management, care navigation, utilization review, and case management.
Services
UTILIZATION REVIEW
WELLNESS
CHRONIC DISEASE MANAGEMENT
Chronic Disease Management
An integrated care approach to managing illness which includes screenings, check-ups, monitoring and coordinating treatment, as well as patient education.
Utilization Review
PRIME Dx provides Medical Management, fully-integrated advanced utilization review under the supervision of Dr. Gary Beach, our Medical Director. We examine each inpatient admission to determine whether it is medically necessary, and whether it is going to be provided at the appropriate level of care. Our staff is supported by a powerful medical management system (DeerwalkOne Care Manager) and evidenced based clinical criteria (InterQual). With experienced registered nurses, we maintain a very low average length-of-stay, thereby reducing plan costs.
CASE MANAGEMENT
Case Management
Designed to improve quality of patient care. Case managers provide individuals a better understanding of specialized care needs, access to specialty care services, education on more cost-effective patient care, and direction toward in-network providers.
Wellness
We believe the most effective wellness programs are custom designed to meet the unique needs each individual and fit the culture of a population
MATERNITY MANAGEMENT
PREDICTIVE MODELING
BIOMETRIC SCREENINGS
Predictive Modeling
Milliman Advanced Risk Adjusters (MARA) offers a new approach to population health risk assessment. Our analytics incorporates a software solution that provides integrated informatics and actionable insights and savings recommendations.
Biometric Screening
A biometric screening captures key health data to identify individuals at risk for health issues such as diabetes, high blood pressure, and high cholesterol. The goal of administering biometric screenings is to reduce health risks, improve quality of life, and reduce overall healthcare costs.
Biometric Screening
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Care Navigation
Our Care Navigation program offers certain surgical procedures at no (or reduced) out-of-pocket healthcare costs for the member. Our preferred surgery centers work with top surgeons and anesthesiologists to deliver high quality care at an affordable price. They do this by bundling services into one single and transparent cost. This eliminates billing and collections, administration costs, and out-of-network risks.
ADVANCED RADIOLOGY
VIRTUAL PHYSICAL THERAPY
Virtual Physical Therapy
This service improves compliance with this vital component to aftercare. By offering these services within the comfort of the patient's home and eliminating the need for someone else to drive them to therapy for multiple times a week, we have eliminated yet another barrier to care.
DOMESTIC MEDICAL TOURISM
Domestic Medical Tourism
The preferred surgery centers we work with are located nationwide and have the best medical professionals to provide the highest quality of care.
Advanced Radiology
Imaging services that are traditionally required prior to surgery can
be expensive. We have partnered with US Imaging Network, a
national network of outpatient imaging providers, to offer advanced
imaging services including MRI, CT, and PET scans at reduced rates
to the health plan and lower or no cost to the member.
HEALTH RISK ASSESSMENTS
Maternity Management
By reviewing the medical history of expectant mothers, Prime Dx nurses identify members with moderate-to high-risk pregnancies and engage them to ensure they receive appropriate care.
Health Risk Assesment
A health risk assessment is one of the first things conducted to determine your health needs and potential for developing chronic conditions.