CARE's Solutions and Services

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.” This expert-based methodology not only lowers costs and increases productivity, but also facilitates innovation.

Our programs include:

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.

Utilization Management Service
Delivering components of U/M to health plans and Providers, including:

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

Case Management Solutions
Delivering components of CM components to health plans, Providers and vendors to healthplans 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 Solutions
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 Services
Delivering administrative components to radiology management vendors, 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 Services
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 Programs
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.

Through an asset acquisition, Care Management International also has well established support capabilities in circulation management, Ecommerce and electronic retailing, and financial services. Click here to learn more about our Non-Healthcare Products & Services.

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 by qualified clinical and analytical 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.