Case Management

project thumb1Medical Helpline Case Management Services deliver coordination of care to improve patient outcomes and patient satisfaction while controlling costs and providing financial oversight. Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided in the most difficult medical cases. We assist in the planning and coordination of care services appropriate to achieve the goal of medical rehabilitation. Our case management may include, but is not limited to: care assessment (including personal interviews with the patient); assistance in developing, implementing and coordinating a medical care plan with health care providers, as well as the patient and their family; and, evaluation of treatment results.  

Case Managers review alternative options for care and negotiate treatment levels and cost to assure that the patient is getting the right care in the right place for the right cost.

Oncology Case Management

Medical Helpline manages patients diagnosed with cancer using a comprehensive integrated approach to link structure and process with desired clinical and financial outcomes. The Oncology Case Management program is managed by our experienced Registered Nurses, who are skilled in managing not only episode of care but the whole care continuum.

Transplant Case Management

Medical Helpline transplant case managers work with the patient, the patient's family and support network to provide comprehensive assistance in all areas related to ongoing education, medical history, medications, development of support systems, lifestyle changes and behavior modifications, and financial options. They communicate with providers, patients and family from evaluation through all phases of transplantation care while working closely with the Transplant Coordinators at the Centers of Excellence. The transplant case managers are certified in Advanced Transplant Management, which enables them to evaluate contracts and identify the best programs based on wait time, outcomes and cost.  

Maternity Case Management

Maternity case management is included in our Utilization Management program at no additional cost. Maternity Case Management promotes positive pregnancy outcomes through education and support during pregnancy.

Neonatal and Pediatric Case Management

This program addresses the needs of premature babies and medically complex newborns requiring special care immediately after birth. Medical Helpline Case Managers work collaboratively with providers to promote evidence-based decisions and work collaboratively in developing a plan of care specific to the needs of each child. The goal of our neonatal program is to manage these complex cases, decrease neonatal intensive care unit days, and coordinate their care needs upon discharge from the hospital and throughout the first year.

Pain Management

Pain is one of the most common reasons people consult a physician, yet frequently it is inappropriately treated. Pain Management costs have escalated in the past 10 years, resulted in expensive and often unnecessary procedures, and may cause unintended addictions to the medications. Medical Helpline's Pain Management Program offers early intervention, ongoing monitoring, and patient engagement to avoid these treatment pitfalls. Members are supported throughout the treatment process to provide positive outcomes to the member and the plan.

Infusion and High Cost Drug Management

Medical Helpline's Infusion and High Cost Drug Program improves patient care and medication adherence, particularly for patients with cancer and diabetes. It can improve outcomes and eliminate medical spending resulting from failure to adequately manage these conditions. Medical Helpline's Case Managers explore options in collaboration with the member’s provider and assist with obtaining the medication and the setup of any infusion needs. Under most prior authorization criteria, clinical information is necessary to verify that a specialty drug is medically appropriate for a patient. By deploying these steps and taking a comprehensive approach to understanding specialty costs, plans can help their members access these important medicines and use them safely and effectively.

Chronic Condition Case Management

Seventy percent of disease is preventable but once an individual has crossed over to a chronic disease, 70% of the events that occur due to that disease are preventable. Medical Helpline's team works to engage members, promote health literacy, and encourage compliance with their care plan as well as positive lifestyle changes.

Medical Disclosure for Underwriting

Provides stop loss carriers/MGUs with in depth clinical assessments on individual members for use when making underwriting or renewal decisions. Reports include treatment or surgical plan with medical and Rx cost projections for the next 12 months.