Our Next-Generation Medical Management
EHN is successful in helping employers control healthcare costs through proven, next-generation medical management services which include:
Nurse On Call
Our nurse on call program is staffed by registered nurses who utilize a combination of software management tools and nursing judgment to assess caller’s questions and symptoms against evidence based guidelines. Access to the service may be utilized as a primary cost reduction strategy. This strategy has been shown reduce ambulatory care by 17% and minor illness utilization by 35%. We find that clients with incentives to drive use of the nurse on call service experience even greater impact on utilization trend and financial returns.
Disease Management
Our disease management programs promote quality care in those with diseases or conditions that are typically high-risk, resource intensive, or prone to stray from evidence-based guidelines. Our objectives are to optimize functional health and well-being by maximizing clinical effectiveness. We do this by increasing knowledge of risk factors, facilitating early diagnosis, avoiding related complications, and eliminating unnecessary, ineffective, and duplicate services.
These disease specific programs encourage patients to follow recommended treatment guidelines, learn symptom management and speak with their physicians about an individualized treatment plan. Through the disease management nurse support services, patients build self-awareness regarding their chronic disease and through disease specific education they learn to self-manage and self-advocate. The programs provide physicians and other care providers with tools and guidelines to promote optimal care delivery for chronic disease populations. Providers are offered timely and targeted medical management information, decision support tools such as flow sheets and decision tree algorithms, distribution of clinical practice guidelines, patient specific gap analysis.
Using claims encounter data, health risk appraisals, physician referral or patient self-referral, the members are identified and stratified based on the severity of their illness, clinical needs assessment and utilization pattern or expense assessment. The process includes identification, evidence-based guidelines, stratification, collaborative practice models and interventions, self management education, feedback to patient and physician, and outcome measures and reporting. Interventions include telephonic assessment, individualized plan and care coaching, access to educational mailings, web-based survey and education, referral to specialized face to face education resource centers, outcome tracking, and access to demand management reinforced decision support and case management for high risk individuals.
Case Management
Case Management is an extension of our Disease Management programs. It is designed to address health management at the individual patient level. By collaborating with the patient, physicians and multidisciplinary team members to help carry out the physician’s treatment, a coordinated plan can be developed to assure an individual’s success. Services include negotiating care and pricing, procuring services and coordinating care. This assists the patient with complex and special needs when navigating a complex health care system.
Data Management
The analysis of 2+ years of employer specific health care encounter data allows us to identify employer-specific cost drivers. This allows our clients to make informed business decisions regarding benefit and incentive program structure. Once a profile has been developed, customized action plans can be built with stakeholders at the table. Additionally, quarterly tracking of outcomes provides opportunities throughout the contract year.
Utilization Management
Traditional Utilization Management with concurrent IP management and prior authorization services take on a new meaning as the nurses work with the patient and provider to optimize the preventive benefits and control utilization by through proactively planning care and pre-screening against established criteria and best practice. To reduce unnecessary administrative hassle, the team focuses on those services where increased information and communication reduce unnecessary or duplicated services.