| Enhance level of care - reduce overall costs
Catastrophic Case Management (CCM) is a process by which patients members with serious, expensive, and/or catastrophic illness or injury are identified and targeted for very early intervention by a BMS CareConnex™ nurse. The ultimate goal of the CCM encounter is to lower overall treatment costs, enhance the patient’s overall level of care, and facilitate the improvement of the entire treatment experience for the impacted member and their family.
Collaborating with the member's physicians
The patient’s physician providers are an integral part of the case management process. Provider interaction is collaborative and non-confrontational; in most cases the member’s physician providers are encouraged by our involvement. Our nurses utilize their own many years of experience in conjunction with industry leading clinical resources such as Milliman when discussing any possible alternate courses of treatment.
CCM - a requirement, not an option
In today’s costly health care delivery environment, CCM is viewed as a requirement rather than an optional service. In fact, it is required by most reinsurers, and is implemented by default for all clients with health plans administered by BMS. Consider this: almost one quarter of all inpatient services are utilized by members with conditions that would be considered catastrophic. Examples include cancer treatment, stroke related conditions, maternity, premature birth, brain or spinal cord injuries, and organ transplants. |
Helps Control Plan Costs
Following are just a few examples of how (CCM) helps control plan costs:
- CCM determines medical necessity of services based upon independent, industry standard clinical criteria;
- CCM, in conjunction with our Utilization Review, are often successful in arranging alternate non-hospital based care in lieu of extended hospital stays or expensive outpatient treatment.
- Researching FDA approved treatments to ensure that the best possible treatment is being utilized.
- CCM often negotiates rates for services or supplies such as Non-PPO hospital services, durable medical equipment, skilled nursing or hospice services, and chemotherapy.
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