True Story #2 Utilization Management Finds the Solution
True Story 2 | July 2016 | Prairie States News |
Prairie States received a call from a member asking for advice. He was unhappy with the care he was receiving for infusion therapy treatments at Hospital A, and the treatments were more expensive than Hospital B. However, Hospital B was out of town and he would have to use vacation days from work to travel to Hospital B for care.
Our Utilization Management nurses worked to find a solution that gave the member the best experience, while addressing cost and location. After confirming Hospital A cost more than $5,000 per treatment over Hospital B, Utilization Management brought the situation to the attention of Prairie States’ President, Vice President of Health Services, Account Manager, and Director of Claims for a more intense review. It was then agreed to forward the information to Coalition Services, to enable them to price the service through a home health agency.
Remarkable Result for the Member and the Bottom Line:
Home Health Services proved to be the perfect solution for providing the best care at the best location and at the best price. Not only was each treatment less expensive (more than $14,000 less expensive than Hospital A and more than $8,000 less expensive than Hospital B per treatment), but the member was able to receive good care in his home—the ultimate convenience.
Prairie States Enterprises, Inc. is a third-party health benefits plan administrator that brings industry expertise and a clinical focus to self-insured companies. Our in-house claims administration, health management services, wellness programs, plan analysis and predictive modeling tools result in remarkable and unprecedented cost control for employers. We also provide the most compassionate and personalized level of service for plan members.