How SummitCare Management Can Help
We offer comprehensive Case Management to those identified
Once a member has been identified, our Case Managers provide: Comprehensive Needs Assessments, Discharge Planning, Care Coordination, Discussion and Coordination of Alternative Treatment and Care Settings, Disease Specific Education, Member Health Risk and Disease Knowledge Assessment, and Disease Knowledge Assessment.
How You Benefit
Our knowledge of managed care and clinical information allows our Case Managers to interact between the patient and the payor. In order to meet quality and cost containment goals, our Case Managers provide the payor with the following benefits:
Better Member Health and Satisfaction
Your health plan members care is followed by our Case Managers who actively engage the member and their providers to ensure the best care and compliance with treatment protocols.
Direct to Lower Cost Providers
Our Care Managers are able to direct members to lower cost providers or in-network providers to minimize the plan and the members cost.
Bundled Pricing or In-network Providers
We have access to alternative solutions that minimize the employees out-of-pocket expense and limit the plans cost. These bundled pricing solutions give the member access to higher quality, lower cost providers.
Cost Containment
Case Management’s goal is to make sure the member is in the proper place and level of care. This limits the plans cost and gets the member to the appropriate level of care.
Out-of-network Claims Negotiation
Our Pre-Cert Department can determine if a provider is in or out-of-network prior to the service being rendered. This early intervention allows us to protect the member and the plan by negotiating with the provider up front for a lower rate.
Early Notification of Catastrophic/Chronic Illnesses
Pre-Certification and Case Management are the front line for identifying potentially catastrophic claims and directing the member to the best setting for care. In addition, they can help members with chronic illness more effectively manage their health and the cost to them.
Reduce Costs
On average, 20% of your enrollees will account for 80% of your overall costs. Summit Case Management was designed to mitigate the financial burden of these high cost patients, while at the same time maintaining timely and appropriate care for patients who are seriously ill. Our Case Managers are able to reduce costs, help the patient receive the best possible care, and maintain a personal and caring approach at the same time.
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