Medical Management Program
Inter-County Student Health Plan includes an integrated medical management program.
Our medical management program works to enhance patient health and guard against unnecessary financial expenditures using nationally recognized criteria. These criteria allow the medical management program team to monitor the appropriateness of member care before, during, and after a hospital confinement and when outpatient treatment is necessary.
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.
Our medical management team consists of highly qualified, licensed health professionals with extensive clinical and medical management expertise. Our medical and professional staff includes in-house medical directors, registered nurses, and other professionals who average nine years of experience in medical management.
Components of our Medical Management Program:
- URAC-accredited Health Utilization Management
- URAC-accredited Case Management
- Maternity Management and Education
URAC-accredited Health Utilization Management
Through our affiliate, AmeriHealth Administrators, we include an in-house Health Utilization Management program that focuses on improving patient outcomes and reducing health care costs by addressing members’ 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 our affiliate, AmeriHealth Administrators, we also include a URAC-accredited Case Management program, which demonstrates a proactive, coordinated approach to support patients with complex or chronic health conditions. The program aims to help targeted members achieve the best clinical outcomes in the most appropriate manner.
By using state-of-the-art risk management tools and applying diagnosis, treatment, and utilization trends, we proactively identify members at risk for serious illness that can result in high costs. The case management team then works with these members and their health care providers to:
- develop individualized care plans
- set health improvement goals
- monitor progress
Case management can benefit both plan sponsors and members through improved patient outcomes, decreased preventable emergency room visits, fewer acute hospital admissions, shorter hospital 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 by 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 pre-delivery absenteeism, and reduced claim costs.
A 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.
