Advanced Plan for Health Logo
 

Search Results

There are 7 item(s) tagged with the keyword "Utilization".

Displaying: 1 - 7 of 7

Ongoing Education on Alternate Sites of Care Can Reduce Inappropriate ER Utilization

With higher and higher ER bills coming in to the plan and members, employers are learning that it’s more important than ever for them to make sure that continual reminders are sent to their employees and members about which conditions can be handled by more convenient and lower cost sites of care such as a nurse advice line, telehealth (which often also covers behavioral health), on-site or retail clinic or urgent care. They’re also sharing details on how to reach these resources, and how much lower out-of-pocket costs will be to members who utilize them versus the ER. Keeping this information top of mind when it’s needed is the key to effective communications in this area.

Tags: ER Utilization, Health Plan, Employers, Telehealth, ER Bills, Urgent Care, Non-Emergent Care, Emergency Room, Utilization
Unexpected Unreasonable Claims Costs in Intraoperative Neurologic Monitoring (IONM)

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health & Joy McGee-Cory - Senior Vice President, Advanced Plan for Health

Several of our Health Plan clients and their members have experienced unexpected and very unpleasant surprises following certain complex surgical procedures – usually spine-related. So we wanted to get a cautionary word out a bit more broadly on this topic to our clients and others who may be facing similar situations. The surprises are coming in the way of bills for intraoperative neurologic monitoring (IONM).

In one case, the billing technician was not a physician, and the member’s bill for monitoring services was an unreasonable, non-negotiable $120,000.

Tags: Health Plan, Surgical Procedures, Healthcare Risks, Intraoperative Neurologic Monitoring, IONM, Out-Of-Network, Top Procedures, Medicare, Utilization
Data: Your Secret Weapon

So, where are your hidden health-related cost centers? The same places they’ve always been: In plain sight. But for the lack of data transparency and integration of data tools and services, they remain elusive to spot. To uncover these cost centers, consider partnering with an analytics firm that not only can access data sets from everywhere patients access healthcare, but also combine them to create nuanced action lists.

Tags: Data, Analytics, Population Health Management, Metabolic Syndrome, Chronic Condition, Intervention, Hospitalization, High Level, Trend Analysis, Individual Metrics, Healthcare Cost Curve, Health-Related, Cost Centers, Access, Transparency, Patients, Healthcare, Action, Medications, Employees, Non-formulated, Specialty Drug, Cost Saving, PCP, Primary Care Physician, Behavior, Pharmacy, Specialists, Network, Employee, Chronic Care, Reduce Cost, Preventable, Emergency, Inpatient, ER, Urgent Care, Copay, Health Plan, Bottom Line, Utilization, Predict, Consult, Drill Down, Follow Up, Biometric, Outliers, High Risk, Wellness Program, Medicine, Case Manager, Patient Population, Poindexter, Advanced Plan for Health, Predictive Modeling
How to Impact Clinical and Financial Outcomes: The NCN Initiative

Improving the health of your employees and health plan, while positively impacting clinical and financial outcomes, is critical to getting the best benefit. This blog explains how to do it. To ensure cost-effective, quality health care, you need to control and manage your health plan like you do your core business. That means making sure that clinical and wellness initiatives are working as intended, and integrated among the member, insurer, plan and the provider team. 

Tags: care management, Nurse, PHM, Population Health, Health Plan, Big Data, claims, pharmacy, reports, employee, cost, wellness, data, transparency, utilization, self-insured, bottom line, poindexter, employer, well-being, biometric data, lab data, medical, clinical outcomes, financial outcomes
6 Costly Healthcare Myths

The healthcare system can be a confusing place for someone who is well, let alone someone who is sick and in need of help. Oftentimes, health plan members do not know their benefits and can seek care in the wrong place; like the ER when the problem is not urgent, or outside their network, which means they may incur an expensive and unexpected bill. This confusion can cause delays in treatment and less than desirable outcomes; as well as an increase of cost to everyone involved--from the patient to the health plan itself.

Tags: ER, Healthcare, Utilization, Health Plan, Hospitalists, Care Physician, PCP, Medications, Inpatient, Readmission, System, Members, Primary Care, Health Outcomes, Provider, Patient, Manage, Poindexter, Data, Claims
By Barbara Rutkowski - Vice President, Clinical Operations
Weighing Wellness with Poindexter

In the advent of Big Data and Predictive Analytics, a time when it is becoming more expensive to remain neutral in regards to company health improvement, 60% of corporations  are attempting to implement effective, cost reductive wellness programs. Does this mean all 60% percent of these companies are experiencing improved ROI and a lower bottom line? Perhaps the easiest way to answer that question is to ask another; does everyone fulfill their New Years’ resolution?

Tags: Wellness, Population Health, Health Plan, Measure, Analyze, Benchmark, Risk Assessment, Big Data, Predictive Analytics, Company Health, ROI, Utilization, Benefit, Analysis, Disease Management, Chronic Conditions
Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations

Dr. Rutkowski is a Medical Management Professional with more than twenty years of experience in operations, integrated medical management for Medicare and self-insured employers, hospital and managed care quality, and employee development.

Tags: Medical, Management, Professional, Integrated Medical Management, Medicare, Self-Insured, Employers, Hospitals, Managed Care Quality, Employee Development, Strategic Business, Health, Systems, Consulting, Organizational Development, Leadership, Team Building, Network, Risk, Clinical, Credentialing, Reinsurance, Regulatory Compliance, Wellness, Disease Management, Utilization, MedisGroups, Outcomes, Design, Development, Vice President, Nursing, University of Florida, Doctor, Education, Indiana University, Registered Nurse, American Journal of Nursing, Chamber of Commerce, Health Care Excel, Operations, Masters of Science

Displaying: 1 - 7 of 7