HEALTH MANAGEMENT

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Using our affiliated partners, and part of our smart health management solutions; we offer utilization management to evaluate the medical need and efficiency of proposed health care services and facilities.  We take on the consideration processes, such as pre-admission certification, con-current review, second surgical opinions and more. A hospital is not necessarily the healthiest place for a person to get well or recover. The CDC reports that health care-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year in American hospitals. In addition, every surgery carries a life-threatening risk. Before having a surgery and taking on that risk, a person should be assured that it is the right approach and necessary to treat the condition, as proven by medical science.  Nationally accepted criteria are utilized in determining medical appropriateness. Continuous monitoring and communication with health care providers allows us to follow the patients throughout their care. Reports are generated to provide data oversight on utilization, savings and impact of the benefit plan. Approximately six to ten percent of each employer’s population experience acute or time-limited illnesses. The inpatient hospital stays and use of new technologies associated with these members can account for a significant portion of health care costs.

Utilization Management  

Using our affiliated partners, and part of our smart health management solutions, we partner with skilled case managers to work closely with patients with severe or chronic illnesses and/or chronic illnesses. These case managers advocate on the patients behalf with the various healthcare providers to ensure services are meeting their needs and receiving the best outcomes.  Early access to Case Management services can provide members with education and support to maintain and enhance their level of wellness and quality of life. Case management encompasses experienced and professional personnel that include claims examiners, employer service representatives, customer service representatives, along with medical and dental consultants. Integrity Administrators, Inc. takes pride in offering each client with responsive, cost-effective services aimed at achieving their healthcare objectives.

Large Case Management  

Integrity Administrators, Inc. allows their disease management and providers to work together to improve a patients quality of life, as well as reduce the number of complications from a chronic disease.  Using our multi-disciplinary management system, we approach addressing chronic conditions, allowing our disease management and providers to work together to improve a patients quality of life and reduce the number of complications from a chronic condition. Chronic diseases are the primary causes of death and disability in the United States. These diseases also bring about major limitations in daily living for almost 1 out of 10 Americans. Chronic diseases are responsible for 7 of 10 deaths each year, and treating people with chronic diseases accounts for 86% of our nation’s health care costs. (www.cdc.gov/chronicdisease/index.htm). Two of these are – heart disease and cancer together accounted for 48% of deaths in 2010. Risk factors that are responsible for these high numbers are High Blood Pressure, Tobacco Smoking and exposure to secondhand smoke, Obesity( High Body Mass Index), Physical Inactivity, Excessive Alcohol Use and Diets low in fruits and vegetables, and Diets high in sodium and saturated fats. Patient education is very important in this area, due to the goal is to improve the long-term health of members and to maintain the benefit plan premium.

Disease Management

Partnering with National Pharmaceutical Services and Magellan RX, we offer the best Prescription Benefit Management using mail order services. We support cost justification utilization to provide to our employers the most efficient and effective drug program. Our full-service and clinically based Prescription Benefit Plans offer our allegiance to providing answers to the escalating cost of prescription programs and positively affecting outcomes. We design our pharmacy benefit management plans to meet the individual needs of our clients, not to provide a “universal” solution. Using Magellan RX Management and National Pharmaceutical Services, we offer a smarter approach to your pharmacy benefits. These companies truly understand our clients’ needs, and provide them with easy-to-use tools, as well as insightful cost saving solution. Integrity Administrators, Inc. partnered with these pharmacy companies to offer the best coverage for self-funded plans, as well as other plans we offer.

Prescription Benefit Management

Using our management system, we make sure to know how your benefit dollar is being used. Our reporting monitoring performance includes:

 

- Monthly Aggregate and Specific Excess Loss Reports

- Weekly and Monthly Claims Check Registers

- Benefit Analysis Reports

- Claims Lag Study

- Eligibility Reports

- Provider Payment Analysis

- Hospital Utilization Statistics

- Diagnosis Analysis

- Provider Comparison Analysis

- Loss Ratio Reports

- Length of Stay/Place of Stay Reports

- Ineligible Claims, Co-payment and Deductible Analysis

Plan Management Reporting  

Contact Integrity Administrators, Inc. to find out more information at 1.800.562.9383 or use the Contact Us tab.

 

 

Phone 800.562.9383    Fax 916.921.3383

Integrity Administrators, Inc.

 

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