Care Management

Helping members achieve healthier outcomes

Care management is for people who need extra assistance and support. It helps them to adopt and stick with proven treatments. Our core care management program includes precertification, concurrent review, discharge planning, retrospective review and case management.

Precertification is an entry point into care management programs. This lets us help members:

• Use their benefits wisely
• Learn about the benefits of using in-network providers, Institutes of ExcellenceTM and Institutes of Quality^® 
• Get referred to other programs, if needed

Concurrent review, discharge planning and retrospective review work together to offer several advantages to members:

• Evidence-based decisions – Based on clinical research and experience, our policies help members get access to appropriate care.
• Integration and technology – Having systems that work together helps us identify and reach members who need our help.

Our case management program coordinates members’ care. Case managers:

• Find members who may need extra assistance through targeted outreach
• Engage members to identify goals, needs and resources, so they can return to better health
• Help members to take an active role in their health and health care by working together to coordinate high-quality and cost-effective care

By helping members achieve their optimal health, we can shape better health outcomes, increase satisfaction and lower overall costs.