Medical Management

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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

An integrated care approach to managing illness which includes screenings, check-ups, monitoring and coordinating treatment, as well as patient education. 

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
HEALTH RISK ASSESSMENTS
MATERNITY MANAGEMENT
PREDICTIVE MODELING
BIOMETRIC SCREENINGS

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. 
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.

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ADVANCED RADIOLOGY
Advanced Radiology 

We partner with US Imaging a national network of outpatient imaging providers, who offer traditionally high cost imaging services at reduced rates to the health plan and no cost to the members.  

VIRTUAL PHYSICAL THERAPY
Health Risk Assessment 

A health risk assessment is one of the first things conducted to determine your health needs and potential for developing chronic conditions. 

Maternity Management

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Predictive Modeling 
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Biometric Screening 
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Advanced Radiology

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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. 

Technology

MILLIMAN ADVANCED RISK ADJUSTERS
CARE MANAGER APPLICATION
MEMBER HEALTH PORTAL
Additional Services
Health Plan Administration
BPO
Services
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