Medical Management Program
Inter-County offers an integrated medical management program.
Our medical management team consists of highly qualified, licensed health professionals with extensive clinical and medical management expertise. Using nationally recognized criteria to monitor the appropriateness of member care before, during, and after a hospital confinement, and when outpatient treatment is necessary, our medical management programs work to enhance patient health and guard against unnecessary financial expenditures. Our medical and professional staff includes in-house Medical Directors, RNs, and other professionals who average nine years of experience in medical management.
Benefits of our Medical Management Program:
- efficient use of health care dollars;
- enhanced ability to predict and budget future costs;
- improved health outcomes and member satisfaction;
- ability to identify and mitigate risk;
- improved health care utilization.
URAC-accredited Health Utilization Management
Through AmeriHealth Administrators, we offer an in-house Health Utilization Management program that focuses on improving patient outcomes and reducing health care costs by addressing health care needs early and diligently. Robust, effective, and URAC-accredited, the program offers these key services:
- precertification (inpatient, outpatient, transplant, maternity, and ancillary services)
- concurrent review
- retrospective review
- discharge planning
- appeals administration
URAC-accredited Case Management
Through AmeriHealth Administrators, we also offer a URAC-accredited Case Management program, which demonstrates a proactive, coordinated approach to support patients with complex or chronic health conditions and to help achieve the best clinical outcomes for members in the most appropriate manner.
With state-of-the-art risk management tools and diagnosis, treatment, and utilization trends, we proactively identify members at risk for serious illness that can result in high costs. Our in-house case management program facilitates improved outcomes and reduced costs.
Using plan and community resources, the case management team works with members and their health care providers to develop individualized care plans and goals and to monitor progress. Case management can benefit both plan sponsors and members through improved patient outcomes and decreased preventable emergency room visits, fewer acute hospital admissions, shorter lengths-of-stay, and reduced overall utilization, where possible and appropriate.
The program strives to attain a balance between quality and cost-effective care, while maximizing the patient’s quality of life.
Maternity Management and Education
The Baby Benefits® program supplements regular prenatal care and doctor visits, educating expectant women about pregnancy and supporting them in following their doctors’ care plans. Healthy pregnancies can result in fewer complications and premature births, increased birth weight, less workplace absenteeism, and reduced claim costs.
The Baby Benefits obstetrical nurse works with the patient and her health care provider to promote a healthy pregnancy and identify possible risks using these tools:
- risk factor identification and health assessments throughout the pregnancy;
- individualized education on how to reduce risk factors;
- 24/7 toll-free access to registered nurses to discuss pregnancy topics;
- a book with detailed information about pregnancy week-by-week and helpful tips for fathers too;
- healthy pregnancy education materials;
- post-partum assessment;
- childhood immunization schedule and suggestions on ways to keep a newborn safe.
