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According to AGI's study, contraceptive coverage improved dramatically between 1993 and 2002 among health plans purchased by employers for their employees.In 2001 and 2002, AGI researchers surveyed insurance companies across the nation, asking whether prescription contraceptives and other comparable drugs, devices, and services were covered in the "typical" managed care plans they wrote for their employers.
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Thanks to wireless technology, case managers working in Chicagos poorest neighborhoods no longer have lengthy waits to get referrals to other agencies for their clients.
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When new members enroll in one of Blue Cross and Blue Shield of Oklahomas (BCBSOK) health promotion programs, they receive free equipment to help them monitor their chronic disease.
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A field-based disease management care program in which nurses meet face to face with members with chronic kidney disease and end-stage renal disease has resulted in dramatic decreases in emergency department (ED) visits and hospital bed days for patients managed by RMS Disease Management Services in Vernon Hills, IL, an affiliate of DaVita Inc.
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When QMed contracts with a health plan to manage its coronary artery disease, heart failure, or diabetes population, the Laurence Harbor, NJ, disease management firm does more than just rely on claims data to come up with a treatment plan for members identified for disease management. The company also sends a team of specialists into individual physician offices to extract data from the patient files of members identified for the program, often coming up with clinical information and medical histories that arent available from the insurance carrier.
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A system to help identify patients who are at risk for suicide, chemical dependency, or premature treatment termination is a great adjunct to traditional psychiatric care, asserts Daryl E. Quick, PhD. Quicks organization, Western Psychological and Counseling Services, uses the ALERT Predictive Modeling and Outcomes Management System from PacifiCare Behavioral Health.
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A system that rates cases by acuity level helps case managers at BlueCross and BlueShield of Oklahoma (BCBSOK) keep their workload evenly distributed. Cases are stratified by complexity, with Level 1 being the lowest acuity and Level 5 the highest.
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An automated calling system reminding members to get preventive health care services has paid off for Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Instead of receiving a postcard reminding them to go for immunizations, cancer screenings, prenatal and postnatal care, and other preventive health care services, members who are eligible for the services receive a computer-generated telephone call.
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With less than a year left before the HIPAA Security Rule goes into effect, a study by URAC has shown that the majority of health plans are not prepared.
