Health Management Solutions
for Improved Outcomes
Medical Helpline delivers experienced health management solutions to improve health outcomes and minimize financial risk.
Utilization Management
Medical Helpline Utilization Management services generate quantifiable improvements in care and savings to both the patient and health plan. Our highly specialized team determines medical necessity, location of care, and appropriateness using clinical expertise and nationally recognized, evidence-based criteria.
We are well versed in:
Reference Based Pricing Plans
Direct Primary Care
Specialty drug vendors
Centers of Excellence
Narrow networks such as imaging
Working collaboratively with other vendors
Download our overview flyer to learn more!
Case Management
Medical Helpline Case Management services deliver coordination of care to improve the patient’s experience and outcomes while controlling costs and providing financial oversight.
Medical case management facilitates:
Recommended treatment plans to assure proven, quality medical care to our members.
Planning and coordination of care services appropriate to achieve the goal of medical rehabilitation.
Alternative care plans when the need arises.
Case Managers review alternative options and negotiate treatment levels and costs to ensure the patient receives the appropriate care.
Your Experienced Case Management Team
Our nurses assist patients and their families in coordinating their physician’s plan of care and plan benefits using a comprehensive approach to link structure and process with desired outcomes for the whole care continuum. Nurses are clinically specialized in:
Oncology
Transplant Management
High-risk Maternity
Neonatal & Pediatric cases
Chronic Condition and Pain Management
Medical Disclosure for Underwriting
We provide medical disclosure documentation for stop loss carriers and underwriters including detailed clinical assessments on individuals, treatment or surgical plans, and future care projections.
Medical Helpline delivers experienced health management solutions to improve health outcomes and minimize financial risk.
Comprehensive Disease Management
Effective management of chronic conditions lowers the potential for disease progression and corresponding high claims costs. Our Disease Management program drives improved outcomes, savings, and member satisfaction.
† Not all clients offer this program.
Program Eligibility
Disease Management is open to any health plan member with a chronic condition. Common chronic conditions include:
Diabetes
Hypertension
Cardiovascular Disease
Arthritis
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Kidney Disease (CKD)
Data Driven Insights Meet Clinical Expertise
Our advanced, fully integrated analytics system serves as a base for predicting future claims. We also provide reporting to assist you with pinpointing unnecessary costs. The data is also used to provide tailored guidance for members from our expert staff of:
Certified Diabetes and Cardiovascular Disease Educators
National Kidney Foundation Kidney Coaches
Functional Nutrition Specialists
Maternity Specialists
Maternity Helpline
Our Maternity Helpline program offers early intervention and education for healthier deliveries.
1 in 5
Women experience a medical complication during pregnancy
Up to 49%
Of healthcare expenditures are from maternity
Prenatal Education
Our comprehensive prenatal education is taught by nurses specializing in obstetric care and case management.
Topics include:
Maternal and Fetal Needs
Nutrition and Dietary Education
Complications of Pregnancy
Childbirth Preparation
Parenting and Work
Behavior Modification
Better maternity care is on the line.