Care Coordination

Health Coachs assist plan members in locating quality healthcare providers that identified as being more cost-effective.  Assistance is also provided for locating the most appropriate care setting for specific health conditions.
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Prevention Management

Members enrolled in the Prevention Management program are assigned to a Health Coach.  The Health Coach will reach out to members telephonically or through on-site clinics to improve the coordination of healthcare access and utilization, and to close gaps in care identified during the predictive modeling phase.  These  include:  Gaps in Care, ER utilization, Medication Awareness, Abnormal Labs, Care Coordination, Referrals, Quoting Benefits.
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Case Rate Negotiations

Primary PhysicianCare, Inc. contracts with a client to perform case rate negotiation services for all scheduled surgeries, hospitalizations and diagnostic tests. As each medical encounter was pre-certified through the medical department, it was screened for potential case rate negotiation. The following steps are performed: In-Network status, Identify discount level, Analyze alternative treatments, Alternative facilities, price negotiation and pend claims for pricing.
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Predictive Modeling
Primary PhysicianCare has developed a predictive modeling software program which identifies and ranks members with chronic diseases based on the risk and severity of the disease.  Our predictive modeling program analyzes up to four data sources: medical claims, prescription drug history, health risk assessments, and screening data.  The software generates a report that ranks members by health risk, indicating their primary diseases, co-morbidities, and risk scores.  The Chronic Member Report can be used to determine the most appropriate intervention plan and programs for intervening with this group.
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