04/14/2010
Concurrent review program expanded to maximize member benefits
In a continued effort to make sure our members are receiving the right care in the most appropriate setting, we are expanding our concurrent review program. Throughout this year, we'll extend an enhanced program to additional hospitals, work with a new service partner (Health Integrated) and add staff to our concurrent review team.
With this expansion we expect to manage about 10% more cases this year than we were able to manage last year.
Concurrent review is a medical-necessity review for facility-based care (acute inpatient hospital, inpatient rehabilitation and skilled nursing facility settings) that occurs while the patient is still in the hospital or receiving care. Our goal is to better manage health care costs and enhance the quality of care delivered to our members by:
- Partnering with hospitals to make sure our members receive appropriate, quality health care
- Reviewing discharge planning to make sure a solid discharge plan is in place to support the member's continued recovery
- Identifying those members who could benefit from a referral to other health care programs, such as case or disease management
If you have questions or want more information, please talk to your Regence Sales contact.
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