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Overview and Levels of Managed Care
Preferred Provider Organization
Utilization Review and Management
Large Case Management
Disease Management
Managed Prescription Plans
Employee Assistance Program (EAP)
Organ Transplant Networks
Bill Review
Overview
Employers are looking to add the advantages of managed care programs and specialty products to further reduce the cost of providing quality health care benefits to employees. Fiserv Health - Kansas satisfies the needs of employers by delivering comprehensive administration, benefit design and consulting services.
After a review of the client's objectives, Fiserv Health - Kansas offers a full spectrum of managed care services. The strategic partnerships with key vendors who provide services complementing our product offerings. These managed care services are fully linked to Fiserv Health - Kansas's administration system and may be bundled or unbundled as required to meet plan goals.
The key to success for any managed care program is the ability to communicate plan benefits and processes to employees. Fiserv Health - Kansas can assist in preparing a comprehensive benefits communication package in support of any managed care plan we administer.
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Preferred Provider Organization
A Preferred Provider Organization (PPO) is an organization of medical providers delivering health care on a discounted, fee-for-service basis. PPOs are one of the most flexible forms of managed care, providing savings and allowing the employee the option of receiving care from any provider. With a PPO, employees have a choice of using in-network providers at lower costs or out-of-network providers for increased co-payments, deductibles and coinsurance charges. If services are received from an in-network provider, both the employee and the employer can realize substantial discounts.
Fiserv Health - Kansas has contracts with national, regional, and local PPO networks that can serve the needs of employers with both single and multiple locations. In fact, we have access to virtually any provider that a customer may choose to use.
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Utilization Review and Management
To be effective, Utilization Management must do a great deal more than screen hospital admissions. The pre-admission process must be reinforced with significant knowledge of medical advances as well as an awareness of medical abuses that drive up the costs of providing heath care.
Utilization Management saves money through the Precertification of hospital stays, specified surgical and diagnostic procedures; Concurrent Review of patient care during treatment in a hospital; Discharge Planning that achieves maximum care at home or alternatively at another cost-effective facility; and Maternity Review for pregnancies.
Fiserv Health - Kansas maintains relationships with selected national and regional Utilization Management firms who can provide managed care support through cost efficient efforts. Through Fiserv Health, our parent organization, we offer our own proprietary Utilization Review solution for our clients.
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Large Case Management
Catastrophic cases, such as head injuries, premature births, transplants and burns, account for only 3% of the total number of employee benefit claims. Yet, these cases can account for as much as 40% of all benefit costs. Identifying and managing these high-risk, catastrophic and potentially high-cost claims is critical to effective medical cost management. It helps ensure that medical care for potentially large cases is appropriate under the terms of the plan from the start, and helps avoid unnecessary expense.
Fiserv Health - Kansas has access to some of the best Case Management services in the industry. When combined with Utilization Management, Case Management can identify potentially high-cost cases and begin managing them as early as the first day that associated claims have been incurred.
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Disease Management
As medical costs continue to go up, employers are realizing that changes to plan design and managed care networks only go so far in controlling cost. Fiserv Health - Kansas, through an affiliated company, Avidyn Health, gives employers real help in driving down the cost of medical care. Our process of reviewing claim data, practice patterns, utilization and case management reports, and prescription drug information can help patients manage their disease and bring about a true reduction in cost.
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Managed Prescription Plans
Prescription drugs are the fastest growing health care expenditure, representing between 8% and 30% of total health care costs. Fiserv Health - Kansas has partnered with the nation's leading managed pharmacy vendors to offer a program of fully integrated services designed to maximize the savings on prescription drug expenses. These programs provide access to extensive retail pharmacy networks, mail order services, and sophisticated claims adjudication systems.
The blend of national purchasing power, wholesale pricing, efficient dispensing, and maximum generic substitution enables these pharmacy programs to provide convenient delivery of quality pharmaceuticals at the lowest possible cost.
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Employee Assistance Program (EAP)
EAPs are designed to assist employees, their family members, and employers in finding solutions for workplace and personal problems. Services may include assistance for family/marital concerns, legal or financial problems, elder care, childcare, substance abuse, emotional/stress issues and other daily living concerns. Among the issues EAPs may address are violence in the workplace, sexual harassment, dealing with troubled employees, transition in the workplace and other events that increase the rate of absenteeism, employee turnover, or lower productivity. The EAP addresses issues that affect employee morale or an employer's productivity or financial success. EAPs also can provide the voluntary or mandatory access to behavioral health benefits through an integrated behavioral health program.
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Organ Transplant Networks
The number and cost of organ and tissue transplant cases continue to increase dramatically each year. In fact, first year transplant costs range from $100,000 to over $1 million. For self-funded employers, this represents one of the most challenging and costly health care services they will encounter.
Fiserv Health - Kansas offers a managed care transplant strategy to reduce costs and provide access to industry leading networks and facilities available for transplant procedures anywhere in the United States .
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Bill Review
We have strategic partnerships with several organizations which can provide comprehensive reviews of provider bills to identify excessive and inappropriate charges. They can also help identify charges that are billed when services or supplies were never provided.
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