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Committed to Quality Care
We are committed to providing quality care. Our skilled and purposeful medical management programs reduce waste, decrease costly emergency visits and hospitalizations, help prevent disabilities that require long-term care, and improve the quality of care for members and the community. The following description of our Case Management Programs explains the interventions we take everyday to provide quality care and avoid unnecessary costs.
Our Case Management Programs
Serious health conditions may require services from several physicians, providers and medical facilities. Good coordination among the providers and facilities is essential to help members become well and avoid unnecessary costs. National studies indicate that members involved in case management programs improve some clinical outcomes, patient satisfaction, quality of life and functional status.
How Many Members are Affected?
Between one and two percent of PHP members have medical expenses over $40,000 and/or personally face a highly complicated medical situation. This small percentage of members accounts for 28 percent of Providence Health Plan costs. When a PHP case manager helps members manage chronic conditions, members are more likely to receive the right care at the right time in the right place and avoid costs.
What's our Goal?
Help eligible members control their health condition better through a planned partnership between the member, doctor, health educator and PHP.
How Does it Work?
PHP members are identified for the case management program through a variety of sources. A team of PHP medical and financial experts reviews claims data, evaluates results from our concurrent review program, and considers physician referrals to help determine which members would benefit from the case management program. PHP nurse case managers contact members to let them know about the program, inform them of program benefits, and ask members if they would like to participate in a case management program specifically tailored to their unique medical condition.
What Medical Conditions Have A Case Management Service?
PHP offers case management services for 22 different medical conditions, including maternity, rare disease, diabetes, cancer and heart disease.
Quality and Costs
Featuring a wide variety of resources to evaluate health services.