LifeWork Strategies provides information
and data management. It also provides medical management. The information
and data management services capture comprehensive claims details including:
Data Warehouse
Standard reporting
Ad hoc reporting
Predictive modeling (ERG's)
Evidence Based Medicine (EBM's)
Provider Performance Indexing (ETG's)
Clinical Claim Chart (CCC) that follows the patient via the web
Medical Management reporting and support
Connectivity and data feeds/management discussion
Web enrollment management
The medical management services include:
All the "turn key" services: UR, CM, DM, etc.
Connection with local health systems Complex Condition Management
Use of information (ERG's, EBM's, ETG's, Clinical Claim Chart, etc.)
Use of local physicians, paying them for managing the tough cases
Can provide clinicians or provide systems/infrastructure
MOTS, the next generation medical management application, integrated with systems, nurse case managers and the local health system
Reporting
ROI
Proven results
Custom networks
Disease Management (DM)
The LifeWork Strategies Disease Management (DM) Program utilizes a comprehensive approach to manage individuals that: 1) have one or more chronic diseases or conditions that are known to have potential debilitating impact (or have just been newly diagnosed with one or more disease or conditions that will likely have a debilitating impact); and 2) demonstrate a capacity to self-manage their condition with the identified co-morbidities.
Identification - Typically uses the same triggering mechanisms for both Case and Disease management interventions (as described above). If a particular case is triggered and then qualifies for Disease Management, the LifeWork Strategies DM registered nurse will contact the Participant to enroll them into the Disease Management program.
Customized Care Treatment Plan - To achieve the best clinical and financial outcomes, LifeWork Strategies develops a customized care treatment plan for each Participant who has been identified for a particular Disease Management intervention. Each treatment plan not only identifies a specific game plan to manage the main condition, but also identifies the key co-morbidities and the follow-up action plans that must be managed to achieve the best, holistic outcome for each patient. LifeWork Strategies DM clinical staff factor into their strategy the entire health experience of each patient.
Intervention - The LifeWork Strategies DM registered nurse will support the individual through the following activities:
Serving as the clinical guide to educate the patient and help promote self-management of the disease(s)
Using Predictive Modeling tools and other clinical research resources to support the patient;
Comparing treatment with evidence-based guidelines or "best practices"
Developing a patient care plan
Educating the Participant and establishing self-management incentives, thereby enabling the targeted individuals to achieve the best possible level of wellness
Promoting interaction with the patient to achieve "buy in" to and compliance with the goals of the DM Program
Reviews the appropriate HealthGrades or other database(s) and then educates the Participant (and if appropriate, their attending physician) regarding the high quality providers/facilities of the applicable health services in the Participant´s region
Working closely with the treating physicians and other treating professionals in part by using the Clinical Claims Chart, Clinical Guidelines, and the patient care plan
Reporting variations in medical practice patterns to the treating provider or appropriate the medical director regarding nationally-accepted Clinical Guidelines or normal reimbursement levels
Using industry standard disease management programs with use of Care Guide Kits and coaching; and
Documenting and reporting on patient and cost outcomes.
Case Management (CM)
Case Management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual´’´s health needs using communication and available resources to promote quality cost-effective outcomes. Candidates are individuals who demonstrate utilization patterns that indicate disease progression and ineffective management of disease.
Identification - Using several methodologies for identifying specific individuals who might benefit from intervention. Initial triggering may occur through utilization management reviews, the referral process, predictive modeling, customized medical management reporting, the third party administrator, and through other identification mechanisms.
Screening - Cases of all covered Participants that are triggered. The Case Manager (CM) will evaluate the individual to ensure the following can be realized: Identification of the best treatment(s) for the condition(s); Assessment of the best setting for the delivery of the treatment; Projection of potential cost savings; and Improvement in patient outcomes.
Open Cases - Typically based upon a standardized assessment by the CM when a determination is made that health care quality and cost can be positively impacted. Cases usually are kept open as long as that impact is deemed appropriate and is expected to produce a return on investment (ROI) of a minimum of 2 to 1 and a target of 4 to 1. Cases are closed when these goals can no longer be met, but can be re-opened at a later time if the expected or target ROI of a Case Management intervention can be re-established.
Intervention - If a particular case qualifies, the CM will contact the Participant to enroll them in the program. The CM will support the Participant through the activities, for examples:
Serving as the clinical guide to support the patient along the continuum of care;
Identifying appropriate clinical guidelines or clinical review criteria;
Using predictive modeling tools and clinical research to support the patient;
Working closely with the treating physicians and other treating professionals in part by using the Clinical Claims Chart, Clinical Guidelines, and the patient care plan;
Comparing treatment with evidence-based guidelines or "best practices";
Reviewing databases to educate the Participant and their primary care physician regarding who are the high quality provider specialists/facilities regarding the required health services in the Participant´s region;
Developing a patient care plan;
Coordinating services necessary to improve health status and impact cost of care;
Facilitating appropriate use of resources;
Facilitating referrals to education programs within the local communities when able;
Educating the Participant and enabling achievement of best possible level of wellness;
Promoting interaction to achieve "buy in´ to and compliance with the goals of Program;
Reporting variations in medical practice patterns to the treating provider or the appropriate medical director regarding nationally-accepted Clinical Guidelines or normal reimbursement levels;
Negotiating price when appropriate; and
Documenting and reporting quality and cost outcomes.
