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Clinical Solutions


HealthReach Predictive Care Management

HealthReach Predictive Care Management®

We identify high risk members based on medical and pharmacy claims to provide one-on-one care management services. We apply a coordinated approach for members that have chronic health conditions that includes employee outreach, physician involvement, nurse coaching and data monitoring. Even minor improvements in member habits and health can deliver measurable results—fewer hospitalizations, fewer Emergency Room visits, less absenteeism, better outcomes and better quality of life. This comprehensive outreach program is designed to provide at risk individuals assistance in making better health choices and decisions to help them reach the maximum health status.

 

Tobacco Cessation

Tobacco Cessation Program

The Tobacco Cessation program is a ten (10) week coaching program that allows members to reach their goal of becoming smoke free. The program offers Participants with unlimited coaching sessions, relapse prevention counseling and educational resources for living a healthier life, free from tobacco and free from the limitations placed on them by their addiction. By using HCS' tobacco cessation program, tobacco users are much more likely to succeed when quitting smoking. Our tobacco cessation program helps employees break their addiction to nicotine through a four step process with a dedicated coach.

 

Care Counselor Utilization Management

Care Counselor® Utilization Management

URAC-Accredited Utilization management program encompasses many aspects of evaluating the plan member care while balancing the plan administration. This program is designed to control costs through the evaluation of medical necessity, appropriateness, and effective use of healthcare services, procedures, and facilities through a combination of prospective, concurrent and retrospective reviews. Additional services available through the Care Counselor® Utilization Management program include Outpatient Services Review and Mental Health & Substance Reviews.

 

Large Case Management

Large Case Management

Comprehensive management of catastrophic injury and chronic care needs. Our Case Manager becomes the primary coordinator, counselor, and patient advocate to ensure that the best quality of care available is delivered to individual patients in the most efficient and effective manner possible. Combined with our Care Counselor program, HCS Registered Nurses refer members to Large Case Management at the earliest possible moment to ensure the most positive clinical and financial outcome.

 

maternicare

Maternicare®

Unlike traditional maternity management programs, MaterniCare® is based on proactive communication with the expectant mother, as well as her doctors, to ensure the best possible outcome for mother and baby. Members who actively enroll in the Maternicare® program will be provided with a dedicated nurse to assist them through the entire program, from start to ­finish. The following resources and services will be provided:
o Customized educational pieces
o High-risk indicators evaluated at critical intervals throughout each pregnancy
o Supplemental Internet resources with a customized website for individuals enrolled in the program
o Proactive outreach and calls to expectant mother from her dedicated nurse advisor
o Unlimited access to a devoted nurse advisor up to 6 weeks following delivery.

 

Medical Information Helpline Icon

Medical Information Helpline

Access to an HCS Registered Nurse 24 hours a day, 365 days a year. Provides callers with toll-free, confidential health care advice and information. The program is based on the premise that informed patients make better and more cost-effective health care decisions.

 

 

URAC Accredited Health Utilization Management