Care Management

Care Management options provide high-impact, cost-effective health management services for clients and members. There are four core components in the Care Management product suite: Personal Care Management, SmartStarts (maternity program), Inpatient/Outpatient Utilization Review, and Catastrophic Case Management.

Whether a member just needs some help and information on managing a chronic condition or has experienced a life-altering event, MedCost has programs designed to meet his or her needs.

Personal Care Management
A personal nurse provides proactive coaching and motivation for patients who suffer from, or are at risk for developing, certain health issues which, if not managed properly, could turn into more serious and costly conditions.

SmartStarts
Prenatal nurses provide expectant mothers with maternity education. Participants receive information they are most likely to need during each trimester of pregnancy. High-risk maternity cases are given additional attention to encourage full-term delivery and minimize complications.

Utilization Management
Utilization Management nurses review both inpatient and outpatient services for medical necessity. Inpatient Utilization Management includes pre-admission review, concurrent review, retrospective review, and discharge planning. Outpatient Utilization Management focuses on the procedures that have been identified as most frequently over utilized, and two programs are available to our clients. The Comprehensive Outpatient Review program includes all elective outpatient surgical procedures, including varicose vein treatment and MRI, CT, and PET scans. The Diagnostic Review option includes only review of MRI, CT, and PET scans.

Catastrophic Case Management
Certified case managers closely oversee the medical care of those suffering from life-altering events, such as strokes, cancer, spinal cord injuries, debilitating diseases, and terminal illnesses, to enhance the patients’ quality of life in the most appropriate setting.