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Comprehensive care management
Our comprehensive and integrated approach to care management is grounded in our strong local presence and relationships, enabling us to provide your employees with personalized support that connects them to the right care and resources. This leads to better outcomes, promotes more informed, empowered decision-making for your employees, and reduces costs through early and targeted intervention and guidance.
We accomplish this in four ways:
Managing chronic and complex conditions
• Monitoring employee health trends and patterns to ensure they receive appropriate care
• Supporting providers in care planning and interventions with robust data and analytics
• Giving employees support and tools that better manage, organize, and engage in care
Supporting mental health
• Facilitating collaboration between primary and behavioral care providers through programs like Quartet
• Increasing access to virtual care, online programs, and digital tools
• Focusing on effective substance use treatment and recovery
• Expanding public awareness with campaigns like #KnowYourMind and #MindPHL
Managing utilization effectively
• Working directly with providers to monitor medical necessity and coordinate appropriate care
• Partnering with expert vendors to span complex and costly specialties
Increasing engagement through health coaching
• Layering analytics on top of data to identify risk, then conduct outreach to engage and educate
• Identifying current and future health risks through targeted outreach to all members by Registered Nurse Health Coaches
• Providing 24/7 access to a Registered Nurse Health Coach, resources, and support for members with chronic conditions
UTILIZATION MANAGEMENT
BY THE NUMBERS
ROI FOR INTERNAL PROGRAMS
COST REDUCTION FOR VENDED PROGRAMS
COST SAVINGS WITH INTEGRATED PRESCRIPTION DRUG BENEFITS
• Helping members with serious illnesses or conditions through case managers
• Sending out targeted clinical messages
• Offering a comprehensive maternity program and
health benefits that support pregnant members
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