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22 May 2015

Care Management as Well as Other New Healthcare Initiatives Provide Outstanding Benefits to Participants

Innovation has come at last to the rescue of America’s struggling healthcare system. It comes in the form of technologically-powered patient care management services that benefit individuals and healthcare providers alike. These services, which encompass not only patient care, but also Capitated Benefit Management and Delegated Benefit Management, will, over the next few years, greatly expand universal healthcare access, something that, despite the ACA, is still sorely needed. Contrary to popular thought, no one benefits from illness. Improved health outcomes and increased independence for patients suffering from chronic conditions such as diabetes, congestive heart failure, COPD, and hypertension are direct results of managed care’s Remote Digital Health management model.

What is Healthcare Management?

Generally speaking, care management is the means through which a team of healthcare professionals meet the needs of patients who require specific care and support. It is a systematic way to provide necessary care. It involves monitoring a patient’s health, often remotely, increasing patient participation and accountability, and eliminating duplicate services. As a result, the overall efficiency of both healthcare services and their associated financials are improved. All healthcare initiatives are a collaborative effort. Through the cooperation of a team of professionals including doctors, nurses, licensed practical nurses, healthcare coaches and others, patient needs are prioritized and efficiently fulfilled.

What are the Benefits of Care Management?

Some of the more obvious benefits of managed patient care include:

  • Higher Value Care. Patients typically get more for their money than in years past with more consistent care, better monitoring, and fewer repeats and lapses in services.
  • Greater Patient Participation. In a managed care scenario, patients receive incentives to play a greater part in their own healthcare, as well as for taking the initiative to engage in preventative measures. Care services are tailored to each patient’s requirements and desires. Patients have a greater sense of control and tend to adhere better to treatment regimens.
  • Improved Efficiency and Flexibility. Care delivery continuity is improved with greater flexibility and efficiency, which, in turn, lowers patient stress and prevents miscommunications.
  • Cost Control. With improved patient oversight and care delivery management, the overuse of local services such as emergency rooms is avoided, as are many hospitalizations.
  • Patients Enjoy Greater Independence. Not only do patients tend to realize greater independence from needing constant care, but they also gain the help required to navigate what often seems to them to be a complicated healthcare system.
  • Reduced Patient Healthcare Expenditures. With managed care, patients typically spend less on healthcare, with better results than in the past.

What is the Best Way to Receive the Benefits of Managed Care?

Participation by means of a proprietary remote digital health service, such as myNEXUS, is the most direct route for all players involved in any patient care scenario to enjoy the benefits of cooperative managed care. Payors such as insurance and health plan providers, as well as healthcare providers and patients, benefit from the behind the scenes solutions myNEXUS provides, such as Capitated and Delegated Benefit Management and incentives alignment. With myNEXUS, responsibilities such as precertification, case management, concurrent reviews and discharge planning become automated. In particular, myNEXUS:

  • Maximizes STARS, HEDIS, as well as other quality incentive ratings via improved data collection.
  • Proactively identifies undiagnosed conditions, which positively impacts patient outcome as well as risk adjustment.
  • Offsets home-based healthcare costs by instituting risk-based management, unit cost, etc.
  • Partners with high-quality home health providers.
  • Improves overall care quality with the utilization of their proprietary data and analytics collection system.

About Capitated Benefit Management

The details of capitation should be of great interest to patients for, in many ways, they are the engine providing the impetus for many of the healthcare innovations currently supplying better care for reduced costs. A capitated contract is a type of healthcare plan that entails a flat rate for every covered patient. The managed care organization pays this money to a healthcare provider for specific services. The patient is allowed to see his healthcare providers as often as is necessary, without incurring increased charges. Costs are patient based, not visit based. The healthcare provider receives the patient fee whether or not the patient requires his services. The more often a patient requires healthcare services, the less the healthcare provider makes. This provides the healthcare provider with incentive to increase the quality and availability of preventative care he offers his patients who, in turn, experience greater wellness.

Specialty Benefit Management

SBM is another cutting edge area of improved healthcare management. It, too, helps to streamline efficiency while reducing waste and increasing wellness, particularly in the area of pharmaceutical spending. It provides the means to provide appropriate and proper care for those chronically ill patients who suffer from serious, long-term conditions such as pulmonary hypertension, the deficiency of growth hormones, cancer, hemophilia, rheumatoid arthritis, multiple sclerosis, hepatitis C and others. These are often conditions that often cannot be cured and, thus, must be managed in a cost-effective manner that best provides relief to the patient’s suffering and prevents to the degree possible, future health crises. SBM uses a combination of both preventative and wellness tactics, such as early diagnosis and intervention to provide the best patient outcome possible.

Everyone benefits with these long-overdue innovations in healthcare management. Such structures and strategies provide incentives for increased wellness across the board. Healthcare providers have the incentive, perhaps for the first time, to be financially vested and rewarded by their patients’ well-being, which results in better patient education, better communication, and more attentive care. Cash flow is improved on the part of the healthcare provider as collection costs are eliminated. Everyone involved in the healthcare equation benefits. Managed care is a win-win proposition.

If you are interested in learning more about how myNEXUS can help manage your Specialty Benefits, they can be contacted here.

Category: Benefit Management, Care Management, myNEXUS News, Telehealth News