Proactive Care Management

Strengthening the fiscal health of the plan and improving the clinical health of the plan member.

Improving Health

What’s Inside the Box

INETICARE mitigates your claim exposure through its unique approach to:

  • Utliization Management
  • Case Management
  • Disease Managementt
  • Maternity Management

INETICARE’s combined program ROI for 2013 was $8 saved for every $1 spent!

Utilization Management

Current Claims Risk Mitigation

  • 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

Case Management

Disease Management

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

Case Management

  • Cancer
  • Chronic Kidney Disorder
  • Bariatric
  • Orthopedic
  • Transplant
  • Speciality Drug
  • High Risk Pregnancy
Put Savings In Your Wallet

INETICARE identifies these catastrophic events through its proprietary data mining, predictive modeling and gaps-in-care tools.

Nurse Interventions as specifically related to:

  • Appropriate for level of care
  • Appropriate treatment
  • Center of Excellence management

Outcome Impacts:

  • Admissions per 1000
  • Days per 1000
  • Length of Stay

Disease Management

Medical Activity Continuum = Biometrics & Behavioral Change INETICARE’s Incentive Driven Chronic Illness Improvement Process

Process Tools

  • MAC = Medical Activity ContinuumTracks outcome compliance measures specific to members chronic illness designation.
  • B1 = BiometricsEstablishes biometric basline opportunities to improve member chronic illness severity
  • B2 = BehaviorEngages member through simple strategies to improve biometric outcomes

Focused Chronic Condition Management

  • Diabetes
  • Cardiac
    • Coronary Artery Disease/CAD
    • Hypertension
    • Congestive Heart Failure/CHF
  • Respiratory
    • Asthma
    • Chronic Obstructive
    • Pulmonary Disease/COPD

$0 Co-Pay Incentive

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.

Maternity Management

H.U.G.S Helping “U” Get Started

  • Pre-Pregnancy Coaching
  • Assigned Maternity Nurse Care Manager
  • Coordination of Care & Services
  • Pre-Natal Passport to track opportunities & necessary check upsfor the expectant mother
  • Optional Incentive Programs to encourange participation

Mobile Engagement

INETICARE's Mobile Engagement

Connects participants with collaborative care thereby increasing adherence to health and wellness programs, resulting in improved medical outcomes and reduced healthcare expenses.

  • Flexible technology
  • Promotes engagement & self-management
  • Members receive testing, medication and wellness reminders
  • Participant data relayed via smart phone to online personal health record, providing clinicians current health status information
  • Sends healthcare professionals alerts about urgent medical situations
  • Increased medication adherence
  • Reduction in ER visits, hospitalizations & readmissions
  • Decreased medical complications
  • Care Management efficiencies
  • Increased wellness and quality of life

The INETICO Advantage

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.

  • Total integration of care & claims data provides the greatest opportunity for positive clinical and financial impact for the plan and member
  • Medical and pharmacy claims data mining is performed weekly by experienced legal and clinical professionals to identify opportunities for program inclusion or financial recovery
  • Proactive identification of candidates at risk or with chronic conditions for targeted outreach & program enrollment
  • Instant identification of high-risk diagnosis triggers and early identification of third party liability claims at the time of pre-certification
  • Personalized approach generates member satisfaction
  • Collaboration with stop loss to manage high dollar cases
  • Superior ROI results
  • Compliance based incentive programs ensure greater member participation, enhanced clinical outcomes and greater savings for the plan

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