Care Management
Disease Management
Improved Health and Productivity. Certain conditions require significant self-care efforts by a patient. Disease management (DM) is designed to keep these patients motivated and on the path to recovery. This system of coordinated healthcare interventions and communications improves the health and productivity of our members. DM utilizes proprietary predictive modeling software to provide fully-integrated DM tools, resulting in decreased absenteeism, lowered health plan costs, and improved member health. Read More...
Case Management
Tangible Results. For patients with complex or catastrophic medical conditions, Primary PhysicianCare initiates case management (CM) services. CM encompasses the supervision of patients who typically have experienced extended surgeries, lengthy hospital stays, and/or ICU. Our CM nurses assist these patients through each phase of treatment- from securing appropriate care through coordinating follow-up treatments. The results are tangible—healthier people result in lower costs. Our members save an average of $20 for every $1 spent on our CM services. Read More…
Onsite Care
Preventative and Acute Care. As part of our fully-integrated approach, Primary PhysicianCare arranges for the placement of a healthcare professional on the premises of the member company. In addition to being a licensed nurse, nurse practitioner, physician, or other medical provider, this professional is trained and monitored to ensure the high standard of care on which we pride ourselves. Read More…
Maternity Management
Healthy Mothers and Infants. Primary PhysicianCare cares about mothers and their infants. Maternity Management uses risk assessments to identify the risk levels of mothers-to-be and their pregnancies. This information is applied to determine appropriate levels of care and to develop customized care plans. Our experienced obstetrical nurses answer questions and offer guidance, providing ongoing one-on-one support and care coordination. Maternity management monitors pregnancies for medical conditions in both low-risk and high-risk situations. Read More...
Precertification
Appropriateness of Care. Our precertification service reviews prospective inpatient hospitalizations and outpatient procedures to ensure that all patients receive optimum-quality and cost-effective care. Precertification determines appropriateness of care associated with all hospitalizations as well as with certain costly or moderately complex procedures, benchmarking all treatments with published evidence-based guidelines. Primary PhysicianCare's fully-integrated approach means that our medical staff has direct access to all areas of our operation—from customer service through claims. The result is fast, accurate, and efficient review decisions and issue resolutions. Read More..
Utilization Review
Quality of Care. Our members can rest assured that they are receiving the highest quality of care in the most cost-effective manner available. Trust our nursing team to monitor treatment progress and to ensure the receipt of the most fitting care. During hospitalizations, our team makes rounds every two days to verify that care is proceeding on an appropriate timeline. As a result, patients experience superior health outcomes more quickly, hence diminishing the need for costly treatments, hospitalizations, and prescription medications. As a proactive resource, Utilization Review addresses each case individually, evaluating care options and giving providers and members the information they need to make informed choices. Read More…
