It’s a simple fact that if you identify a concern early,
it’s easier to remedy or eliminate it. The same logic works
with the Avidyn Health case management program. Case management
solutions focus on the 1 to 2 percent of health plan members that
drive 30 percent of health plan costs. Avidyn Health solutions
facilitate a strong, cohesive relationship between members, providers
and the payers in order to optimize medical expenditures and health
outcomes. Our technology allows for 'real time' data transfers
and easy access, in-depth reporting for our customers.
The program serves to empower, educate and assist the member,
and family, who are experiencing catastrophic illness or injury
or are struggling with the management of a chronic disease. Areas
of expertise within case management include:
- Brain and spinal cord injury
- Severe neuromuscular disorders
- Respiratory failure
- Trauma
- High-risk maternity/pediatrics
- Behavioral health
- Severe burns
- Cancer
- Stroke and transplants
Providing effective assistance - early
Our case managers use state-of-the art predictive modeling tools
along with our managed care system to set edits and triggers for
identifying cases to notify employers when accumulated costs hit
50 percent of their stop loss specifications. This early warning
system is a result of our 'proactive, not reactive' approach to
health care that has a proven track record of preventing and delaying
the onset of chronic conditions.
The case management specialist works intricately with the member’s
attending physician to address many concerns. Some of these concerns
include addressing the specific medical/psychological needs of
the member, mobilizing the appropriate resources for care over
the course of the illness, use of health care professionals that
are qualified in specialized care, and identifying cost effective
alternatives for care. All of these objectives are considered
while continuing to optimize the quality of care and focus on
the concern of conserving medical/psychiatric expenses.
A first-class program
We work hard to provide the best case management program to the
member. Early intervention and cost-effective services allow a
positive return on investment for the employer.
The essential components of our case management program include:
- Assessment-collecting in-depth information
about a person’s situation to identify the individual’s
needs in order to develop a comprehensive case management plan
to address those needs
- Planning-determining specific objectives,
goals and actions designed to meet the client’s needs
as identified through the assessment process, and resulting
with plan a that is action-oriented and time specific
- Implementation-executing specific case management
activities or interventions to achieve the goals set forth in
the case management plan
- Coordination-organizing, securing, integrating
and modifying the resources needed to reach the goals set forth
in the plan
- Monitoring-ongoing process of gathering
sufficient information from all relevant sources about the case
management plan and its activities or services so that the case
manager can determine the plan’s effectiveness
- Evaluation- determining the case management
plan’s effectiveness in reaching desired outcomes by monitoring
the plan at appropriate times, and may lead to a change in the
case management plan, either in its entirety or in any of its
components
The member’s best interests are promoted by advocacy for
necessary treatment, alternatives, timely care and coordination
of health services throughout the case management program process.
We believe that quality care from the beginning will limit the
major complications and expenditures in the future. Addressing
the needs of members with catastrophic illness and chronic diseases
early will benefit the employee and the employer in the long run.
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