Care Management

Health Design Plus is successful in controlling costs while maintaining member satisfaction because it brings the personal touch to care management. Members have ready access to dedicated, experienced nurse managers who have an average of 20 years of experience. Cases are rigorously managed to see that appropriate, effective treatment is provided. We verify that treatment meets medical necessity criteria for the patient's condition, considering length of hospital stay and outpatient treatment possibilities. Because HDP provides an intensive nurse manager ratio, members receive personalized attention about their questions and concerns, and referrals to Good Health by Design education and wellness programming and locally-based resources where needed.

Care Management Services:

  • Focus on patient advocacy and education
  • Precertification of patient admissions, outpatient surgeries and high cost tests
  • Nursing case management and discharge planning
  • Inpatient and outpatient utilization management
  • Intensive management of high risk cases
  • Proactive management of costly cases
  • Concurrent and Retrospective claims analysis

HDP's Care Management can reduce the rate of increase of your medical trend. HDP features a range of programs to assist patients in navigating through the complex health care system. These programs have proven effective in managing care and controlling health care costs. We deliver these services in a responsive, personalized and comprehensive manner.

Sample Savings from Care and Utilization Management

These are results that can be measured!

Health Design Plus utilizes a three-pronged approach to cost control:

  • Care Management to reduce the rate of increase, keeping costs under control.
  • Network discounts to lower the cost per unit of healthcare
  • Exceptional plan management to ensure appropriate payment.

Our expertise in utilization and care management controls the amount of healthcare services utilized while ensuring that members receive appropriate care. Our founding principal is to support every participant in acquiring the right care, at the right time, with the right provider, in the right place and at the right price.

savings chart

Outcome based on HDP 2012 book of business

Source: Health Design Plus Client Data, 2012