Integrated Utilization Management Improves Outcomes and Savings for Customers

September 24, 2019

To combat escalating healthcare costs, HealthComp has spent years developing integrated medical management programs to help our customers achieve quality outcomes for their members and savings for their bottom line. As part of this mission, we continue to invest in our in-house Utilization Management (UM) department to help our growing base of customers achieve improved results year after year. The UM department provides services like utilization review, case management, disease management, prenatal programs and targeted programs for cancer and ER visits.

 

Customers who leverage HealthComp’s UM programs have seen a healthcare cost trend of just 1.1% over the past five years*. In comparison, the industry average for healthcare costs has increased by 6.4% within the same time period**. Additionally, our UM programs nurture an industry-leading engagement rate of 44%. This is crucial as members need to engage in order to reap the benefit of these programs, which can ultimately help to improve their health.

 

To continue to facilitate these impressive results, HealthComp continue to invest in our UM team. The UM department now represents over 10% of total HealthComp employees. Together, this team serves over 250,000 plan members.

 

To lead this growing team, we recently brought on board Arnel Mondejar, RN, BSN, CCM, to serve as our new Vice President of Utilization Management. Arnel has more than 10 years of experience as an RN and clinical management executive with strengths in managed care and health plan operations. He also has in-depth expertise in healthcare regulatory compliance, process improvement, and new program implementation.

 

“I’m excited to be a part of the HealthComp team,” said Arnel. “HealthComp has been a market-leading health benefits administrator for more than 20 years. It has a long legacy of success and yet it sustains an innovative mindset, striving to develop and offer creative out-of-the-box solutions to help address today’s most complex healthcare challenges. I’m excited to bring my skills and expertise to the table to broaden and deepen HealthComp’s clinical programs and to ensure white-glove member experience and cost-containment measures work side by side to satisfy our customers.”

 

Under Arnel’s leadership, our UM team will fine-tune our care management and advocacy programs. Our UM programs will continue to help clients reduce healthcare spending while optimizing the health outcomes of program participants.

 

HealthComp’s UM programs include:

 

  • Utilization Review and Pre-Certification – Conducted by onsite nurses in accordance with Milliman Care Guidelines and your specific plan benefits.
  • Dialysis Claims Management – Program reduces dialysis costs to 125% of Medicare for eligible members.
  • Case Management – Our case managers facilitate savings through care coordination, continuity of care, claims review and negotiation, and member education.
  • Mommies 2-B – Personalized programs for expectant mothers to promote a healthy pregnancy. Services include maternity screening, counseling, and case management.
  • Cancer Awareness – proactive approach to closing gaps in care and preventing future occurrence of cancer-related illness. Also identify target candidates to raise awareness for approach cancer screening.
  • Emergency Room Solutions – Identify members who have recently used ER services and educate them on alternative, lower-cost care solutions (e.g. urgent care, telemedicine and primary care).
  • Advanced Analytics – Our analytic tools provide clear insights into how these UM investments work for you and your members.

 

*HealthComp clients’ medical trend represents average medical and administration per-employee-per-month (PEPM) costs. This does not include stop-loss reimbursements. The four-year period is 2013-2018.
**The industry average was obtained from the PwC Health Research Institute’s report, “Medical cost trend: Behind the numbers 2019.

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