Prairie States’ in-house health management, wellness, and concierge programs increase employee engagement and lower health plan costs.

Registered nurses, who comprise over 30% of our staff, provide unmatched clinical expertise. Members speak with the same dedicated team each time they contact us so they don’t have to repeat their story. Then through integrated data analysis and collaboration, we’re able to improve member health and the bottom line.

Health Management Wellness Program

Utilization Management

Utilization Management ensures that members get the right care in the right setting at the right time. Prairie States’ nurses review the use of healthcare services, carefully weighing matters of medical necessity and efficiency. They provide expert guidance, always in accordance with the provisions of the plan.

Pre-certification requirements are tailored to keep up with industry trends, always with an eye toward what’s best for the patient. Using up-to-date evidence-based guidelines and literature, our nurses evaluate care and coverage options. Working with board-certified physician medical reviewers, they seek the most appropriate and cost-effective setting. We also work closely with providers to coordinate length-of-stay and discharge planning while giving members information that can speed recovery and reduce readmissions.

Case Management

Our Registered Nurse Case Managers advocate on behalf of members facing severe and complex conditions such as:

  • Cancer Care
  • Transplants
  • High-Risk Pregnancy
  • Dialysis
  • Traumas
  • Multiple Chronic Conditions

While guiding members through the complexities of 21st century healthcare, we provide the quality care they deserve and significantly lower plan costs. Our RNs stay engaged with members throughout recovery to reduce complications and avoid costly readmissions. After major surgeries, inpatient stays, and maternity, our nurses also manage transitions of care, including detailed discharge education and follow-up. Early intervention is key, allowing us to obtain the best outcome for the patient and the best value for the health plan.

Condition Management

Chronic conditions such as asthma, cardiovascular disease, diabetes, and lower back pain can all be effectively addressed through Condition Management. Our nurses work directly with members to develop a care plan that can improve health and wellbeing.

Education is key. The more members know about their conditions, and the more proactive they are in seeking treatment, the better the outcome. Condition Management nurses provide guidance and counseling, informing members of new or modified treatments, identifying appropriate healthcare providers and tracking progress.

Condition Management is an extremely effective cost-savings tool, reducing the frequency and expense of doctor visits, emergency room visits, and hospital stays.

Vitality Essentials: Wellness Program

An organization’s effectiveness depends on the health, happiness, and productivity of its employees. Improve the overall wellbeing of your staff with our Vitality Essentials wellness program. For over 20 years, our customers have embraced our in-house wellness as a valuable asset, driving improved group health through personalized focus on education and engagement.

  • Health questionnaire with biometric data integration
  • Health coaching with care plans and unlimited calls to promote healthy lifestyles
  • Wellness Portal with on-demand virtual classes, form submission, incentives, and more
  • Bi-annual Lunch & Learn presentations for employees
  • Activity administration and reporting