Proactive Care Management
Strengthening the fiscal health of the plan and improving the clinical health of the plan member.
Pre-Certification Verification of medical necessity & appropriateness of care
Prospective Review Review of claimants medical status and proposed procedures, determination of medical necessity and prior negotiation of cost containment opportunities
Concurrent Review Performed during inpatient hospitalization to evaluate future intervention
Discharge Planning Ensure patient receives the best care using the most appropriate health services in the right location following inpatient discharge
Retrospective Review Alignment with medically necessary care and post service negotiations resulting in cost containment opportunities
Pre-Notification = Pre-Treatment Claim Negotiation
Advanced Cancer Management
Pre-Dialysis Treatment Capture
Out-of-Network to In-Network Redirection
Pre-Claim Subrogation Intervention
Focused case management reduced hospital admissions by 38%, in-patient days by 36% and ER visits by 30%, thereby reducing overall costs by 35%.*
* Source: The American Journal of Managed Care, the Carnegie Mellon University led study
INETICARE has proven that a $0 co-pay incentive program for a member’s chronic illness medications improves overall participation from an average of 14% without incetives to 64% to 75% with incentives!
*Eligibility for $0 copay incentive is only available for members who are 100% compliant with the MACB2 Program.
Connects participants with collaborative care thereby increasing adherence to health and wellness programs, resulting in improved medical outcomes and reduced healthcare expenses.
INETICO’s solution to rising healthcare costs is an intetgrated strategy that includes unique and proprietary elements, all seamlessly managed through our web-based system.
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