You now hold the key to offer your plan participants the strongest tools to maintain good health and contain claims cost. Many inpatient stays may be prevented or shortened through regular periodic contact with patients whose medical condition requires compliance with a daily plan of care that assures optimal health and quality of life. As Critique holds the line on medical disease states you easily hold the line on medical costs.
As you learn about Critique, you may find, Critique’s services go beyond ordinary medical management. As Critique helps you identify tomorrow’s large claims, you may find identification and medical compliance is the key to lower medical costs.
Prospects for Chronic Disease Management may be identified or recommended by:
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• The claims payor (based on claims with certain documentation) through the predictive risk model
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• Prescription card company reporting
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• Transfer from Large Case Management to a "Chronic Disease Management" status.
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• Utilization Review on inpatient stays not requiring Large Case Management
Beneficial intervention helps prevent flare-ups of conditions that require hospitalization.
The following graph depicts the areas where Chronic Disease Management, which includes NurseMonitor™ technology and nurse health coaching, prevents costly medical events.
The cost of medical care increases over time. Preventing medical events, such as a heart attack or hospitaliztion for diabetes, slows the increased expenses.
