Optimize Value of Therapy Services
CareConnections is designed to perform quality and utilization management functions for insurers and self-insured companies (any company purchasing medical services that include rehabilitation). Our system enables you to recommend clinical best practice principles to your providers, to measure success, to coordinate utilization, to limit outliers, to assess patient satisfaction, and to monitor and increase the value for your physical therapy paid claims.
CareConnections makes best practices real and in real time. It is a prospective and proactive way to improve the performance of your provider panel. It limits the number of cases going to case management, while providing concurrent clinical assistance for those that do. CareConnections also allows continuing retrospective review of clinical outcomes, documentation issues, and utilization behavior by clinic and provider.
Frequently Asked Questions
- What is CareConnections?
- What is it like for the providers?
- How do I make it work with my provider panel?
- What about support?
- By better managing my rehabilitation panel, how much will I increase my value?
What is CareConnections? The Answer To Your Questions!
There are so many questions. You provide your customers with a preferred rehabilitation panel of providers. You pay their claims and you wonder:
- as an UNDERWRITER, how do I evaluate the rehabilitation services we purchase?
- as a MEDICAL DIRECTOR, what are clear clinical practice parameters for physical and occupational therapy?
- as a CASE MANAGER, what are appropriate guides for rehabilitation goals and therapeutic interventions?
- as a QUALITY ASSURANCE / UTILIZATION MANAGER, what measures and controls can I use to coordinate my rehabilitation providers?
What Is It Like For the Providers?
For therapy clinics it’s as easy as purchasing an airline ticket on the Web. The CareConnections Web site can administer the entire set of selected services for you. Providers simply make a brief online initial registration to collect their authorization and treatment guidelines by entering insurance information and clinical baseline status. It takes about 5 minutes and can be done at any time. Busy provider offices can work it into their schedule 24/7.
Subsequent requests for care are just as easy to enter but are often unnecessary due to CareConnections’ “smart” application of initial authorizations based upon the patient’s initial clinical status. Providers also gain printable or electronically storable documentation as records for their coordination with claims submission.
Your therapy providers remain professionally autonomous but clinically integrated. They gain from quarterly clinical outcome and patient satisfaction reports. They have data to help them improve their care, determine their continuing education needs, assess their clinicians, market their practice, and benchmark their capabilities and services with their professional peers. You, the payer, can access the same information.
For the physician office, it eliminates elements of referral coordination and ongoing management of requests for therapy care. Appropriate frequency and duration of care (per established treatment guidelines, written by and for physical therapists) are applied initially to avoid additional paperwork, phone calls, and potential delays in patient treatment or discharge. Doctors need only refer the patients for care with their usual goals for return to function. CareConnections will then advise and help the therapists to achieve the desired outcome by giving them valid tools for measuring the patient’s progress, which can then be reported back to the referring physician.
How do I make it work with my provider panel?
CareConnections provides you with the opportunity to activate the medical necessity, quality assurance, and utilization management provisions of your contracts with providers. It makes these components alive and online.
After you select your CareConnections quality and utilization management options, a provider mail-out with instructions alerts your panel and provides them with details for acquiring their login and password. A tutorial will show them step-by-step procedures to register data and to retrieve clinical care advice and/or billing authorization, including one of over 85 guidelines. Statistics are also generated to create the necessary expectations for patient results.
What about support?
CareConnections therapy case managers can help providers, your case managers, and medical management staff. A toll free number allows providers to contact technical support for help with registrations or to contact experienced clinicians, physical therapists, and occupational therapists to assist them with interpretation of clinical guidelines.
By better managing my rehabilitation panel, how much will I increase my value?
Improved clinical quality can be difficult to measure, however, CareConnections’ best practices model can help to improve poor outcomes that generate time loss, over utilization, case management expenses, and potentially more radical and invasive procedures costing thousands more in physician or hospital charges.