Your CARE Opportunity

CARE creates customized programs that achieve superior results by applying “the right talent, to the right task, at the right time, using the right cost structure.” This expert-based methodology not only lowers costs and increases productivity, but also facilitates innovation.

CARE’s services can be provided from a variety of locations via in-bound and out-bound telephone, email, live-chat support, and traditional internal office methods, and are available around-the-clock, both on a real-time basis during our clients' business hours, and on a consultative or flex-time basis at any time. Our offices are staffed with qualified clinical, analytical, and customer service trained professionals and we associate with best-in-class, well-established partners. CARE complies with all State and Federal regulatory and accreditation requirements and standards and our model provides staffing and support for non-regulated components of clinical processes; leaving core and regulated functions in our clients' control

CARE provides value to its clients by:

Care Management International enhances the value of our clients' care management activities with a comprehensive range of services that improve outcomes, optimize performance, lower costs, and frees up resources allowing increased innovation.

CARE provides value to its clients by:

»	Providing insight and expert program design in areas traditionally burdened by complex regulations, complicated technology, and misaligned incentives,
»	Delivering time-sensitive indications of clinical need with usable data so patient interventions and interactions can be maximized,
»	Addressing the gap that exists between a client’s ability to assign resources (including recruiting, staffing, training, scheduling, and technology) and the level truly required to obtain their desired program results,
»	Systematically supports client retention, control, and optimization of critical decisions,
»	Achieving cycle-time advantages and time-of-day flexibility through a 24/7 schedule,
»	Determining which elements of a complex and regulated business process can be conducted offshore, onshore, or with technology,
»	Supporting customized data and reporting applications or working directly within client systems and workflows, and
»	Freeing-up client professional staff from administrative duties allowing for greater time, attention and focus on essential activities.
»	Focusing on clinical and administrative processes within healthcare companies that would benefit from process redesign or the addition or replacement of clinical and trained non-clinical talent, and
»	Additionally, clients also see continuous process improvements through CARE’s quality management and formal project management techniques.

CARE’s products and services are designed to achieve the following for its clients:

Improve Outcomes
Clients can receive time-sensitive indications of clinical need with usable data to maximize the impact of their member interventions and interactions. Examples include:

»	Alerting clients of critical gaps in care,
»	Supporting more effective care planning, and
»	Increasing intervention contact rates

Improving Effectiveness and Efficiency
Clients can receive the benefit of CARE’s 24/7 operation in area such as:

»	Overnight work queue preparation,
»	Reduced project cycle-time,
»	Automation implementation support, and
»	Scalable staffing and shift flexibility

Clients can receive the benefit of CARE’s operational flexibility in area such as:

»	Wholesale production from within CARE’s state-of-the-art HIPAA-compliant facilities
»	Staff support from CARE’s facilities while working directly within client systems, and
»	Customized application development and reporting

Freeing-Up Resources
Clients can allow for greater attention and focus on clinical activities by freeing staff from performing administrative duties that do not require the level of capabilities achieved through their education and clinical experience. Types of activities that can be removed from clinical staff include:

»	Claims and case look-up
»	Clinical research
»	Clinical analytics
»	Data entry
»	Data collection
»	Paperwork processing, and
»	Telephonic outreach

Additionally, CARE’s programs:

»	Can be established with simple technical interfaces allowing for minimal client input and minimum implementation cost,
»	Can be highly customized by clinical and process experts to meet the specific care management needs of clients, and
»	Can be started as pilots and small proof of concept programs so value can be proven before large scale commitments need to be made.

Care Management International (CARE) delivers smart sourcing solutions to healthcare companies with a focus on enhancing our clients’ core competencies and effectiveness in care management.

»	Our services are designed by healthcare experts and apply new techniques, global resources, and advanced technology solutions to drive positive clinical outcomes and create true market differentiation for our clients in case management, disease management, utilization management, radiology management, pharmacy management, and data analytics.
»	Our smart sourcing model gives healthcare companies the ability to enhance the value of their medical management programs.
»	Our approach determines which elements of a medical management process can be conducted offshore, onshore, or with technology.
»	Our products focus on clinical and administrative processes within healthcare companies that would benefit from process redesign or the addition or replacement of clinical and trained non-clinical talent.
»	Our solutions address the gap that exists between a client’s ability to assign resources (including recruiting, staffing, training, scheduling, and technology) and the level truly required to obtain their desired program results.

CARE creates customized programs that achieve superior results by applying “the right talent, to the right task, at the right time, using the right cost structure.”

Our healthcare programs include:

Utilization Management Processes
Delivering components of U/M to healthcare and Providers, including:

»	Inpatient or outpatient notification,
»	Pre-certification,
»	Discharge planning,
»	Retrospective review,
»	DRG validation,
»	Claims appeals,
»	Pre-determination, and
»	Data loading services into client clinical systems.

Case Management Processes
Delivering components of CM components to health plans, Providers and vendors to health plans and Providers, including

»	Identification of at-risk plan members,
»	Stratification of at-risk plan members,
»	Establishing member-specific clinical history,
»	Establishing needs-based initial assessment,
»	Performing on-going patient assessment,
»	Data loading services into client clinical systems,
»	Quality monitoring, review and analysis,
»	Case management graduation follow-up assessment, and
»	Performing post-acute follow-up.

Disease Management Processes
Delivering components of DM components to health plans, Providers and vendors to health plans and Providers, including:

»	Identification of at-risk plan members,
»	Stratification of members,
»	Performance of the enrollment/engagement process,
»	Collection of non-claims based patient population information,
»	Developing care plans,
»	Quality monitoring, review and analysis,
»	Conducting health risk assessments, and
»	Conducting follow up calls to assess risk and monitor compliance.

Radiology Management Processes
Delivering administrative components to radiology management programs, including:

»	Intake,
»	Data entry,
»	Eligibility or enrollment verification,
»	Provider notification,
»	Care preparation,
»	Clinical analysis,
»	Data collection and analysis, and
»	Quality monitoring, review and analysis

Data Analytic Services
Delivering components of data analytic services to health plans, Providers and vendors to health plans and Providers that need assistance in clinical data management, including:

»	Data cleansing and loading,
»	Reporting,
»	Quality assurance, and
»	Clinical interpretation for care management or client consumption.

Academic Institution/Commercial Health Organization Research Support
Delivering components of certain services to a variety of healthcare companies that need assistance in clinical research, including:

»	Data collection,
»	Data cleansing,
»	Data loading, and
»	Clinical data management and reporting.

Medical Policy/Clinical Guideline Development
Delivering components of certain services to health plans, Providers and vendors to health plans and Providers that need assistance in creating or maintaining medical policies and/or clinical guidelines, including:

»	Collection and evaluation of primary health research data,
»	Comparative evaluation of existing medical policies and guidelines, and
»	Documentation of results and creation of required documentation.

Circulation Management (Publications)
Delivering outbound telephonic solutions for:

»	Subscription management,Data cleansing,
»	Data cleansing, and
»	Data enhancement activities.

Pharmacy Management Solutions
Delivering customized pharmacy management support services at scale for healthcare companies with a focus on identifying care gaps, compliance and interaction alerts, and other opportunities to improve outcomes and reduce cost, including:

»	Compliance and adherence,
»	Prior authorization of Rx services,
»	Pharmacist support,
»	Therapeutic duplication identification,
»	Poly-pharmacy analysis and recommendation,
»	Fraud and abuse programs,
»	Retail to mail-order identification, and
»	Drug interaction identification.

Outbound Activity

»	Health Risk Assessment (HRA)
»	Discharge Follow-up
»	Coordination of Preventive Services and Reminder Programs (HEDIS)
»	Pharmaceutical Education & Pharmaceutical Switch
»	Care Management and Disease Management Screening and Enrollment, and
»	Pharmacy Compliance

Inbound Activity

»	24/7 Call Triage and Management
»	General and Select High-Cost Prior Authorization(s), including Rx
»	Concurrent Review Support, and
»	Customer Service Intake and Triage

Staff Augmentation

»	Clinical Staff Support (Turnover/Vacancy Management)
»	Non-clinical staff support, and
»	Recruitment of scarce or specialized skill sets.

Data Management and Analytics

»	Analytic staff augmentation,
»	Recruitment of scare staff and capabilities,
»	Predictive Modeling
»	Claims Mining for Disease Management Program Candidates
»	Improvement of client tools, and
»	Comparative analysis of large datasets in order to identify unique areas of opportunity.

Guideline and Policy Creation and Maintenance

»	Research Support
»	Guideline Creation, and
»	Documentation & Maintenance

Care Planning Support

»	Collection of Clinical Data For Select Members
»	Physician Assessment and Assembly of a Clinical Care Plan Recommendation, and
»	Documentation Support

Our Publications Support programs include:

Circulation Management (Publications)

»	Subscription management,
»	Data cleansing, and
»	Data enhancement activities.

Our Ecommerce Support programs include:

Ecommerce Solutions and Services - Including Electronic Retailing and Web Support Delivering a broad capability of technology and transactional services based upon the dynamic application of both web-technology and human resources supporting our clients interactive consumer-based programs:

»	Web-based consumer-facing web portals
»	Order processing,
»	Customer service,
»	Order capture,
»	Post-sales service,
»	Satisfaction survey activity,
»	Email interaction, and
»	Web-based chat activities.

Our Receivables Management Support programs include:

Financial Services (Receivables Management) Providing experienced outbound telephonic customer service agents and sophisticated IT and call center capabilities to companies and financial debt aggregators, including:

»	Small case debt collection,
»	Large case debt collection,
»	Healthcare debt receivables management in a HIPAA compliant facility, and
»	Fraud analysis and prevention

We focus on helping you apply “the right talent, to the right task, at the right time, using the right cost structure” In order to IMPROVE YOUR BUSINESS.