Our program utilizes evidence-based guidelines including NCQA focused standard assessments and screening tools, condition-specific guidelines, and care management-specific assessments targeted to at-risk populations. We work collaboratively to facilitate access to community resources, patient (and caregiver) education, and clinical and behavioral health support across the care continuum:
Complex Case Management provides coordinated health care services for patients who require extensive use of resources and need assistance with coordinating their care.
Care Managers will work closely with the member and their provider to ensure patients receive appropriate and timely medical services. Care Managers will provide the member with options and information so patients can make an informed decision.
Disease Management focuses on helping patients manage their chronic conditions so that complications are minimized, and quality of life is promoted.
A strong emphasis is placed on education, which plays a key role in reenforcing a patient’s knowledge of their medications, diet, physical activity, warning symptoms, and emergency plan.
The collection of patient health data from home through device(s) provided to patients.
The care coordination team will make recommendations and provide resources to the patient, based on RPM data.
Referral Management is a structured referral process to ensure patients receive the right health care services, at the right time, in the right place.
A referral is based on patient need and choice and is consistent with the most appropriate care guideline. Patients enjoy efficient referrals from their PCP to optimal specialists and facility partners.
Utilization Management is the medical necessity review of inpatient and outpatient - prospective, concurrent, and retrospective - healthcare services.
HighCare strives for high satisfaction with timely decision making, maintained network integrity, and reduced administrative burden without jeopardizing total cost of care (TCoC).
We aggregate and analyze data to identify populations at risk, measure cost of care, and share insights:
Helping patients connect with network physicians who are supported by data transparency, clinical quality, and the HighCare care coordination team.
By identifying, aggregating, and unlocking the true value of patient data, the Lightbeam healthcare analytics platform provides the guidance to deliver the right care at the right time while reducing costs and delivering outstanding financial results.
Please CLICK HERE to check quality performance and use supplemental data entry tool.