10/27/2011
Change to Regence care management effective Jan. 1, 2012
Delivering efficient and effective care management is critical to addressing the evolving needs of our groups, members and the market. Our current care management programs, including utilization management, case management, Regence Disease Management, Special Beginnings® and Regence Health CoachSM, have done a great job of supporting members. With Integrated Care Management (ICM) we've enhanced that support by proactively identifying care opportunities earlier and providing targeted engagement and support before gaps in care lead to avoidable ER visits or hospital stays.
ICM is the next evolution of our medical management program suite, delivering targeted whole-person support that's focused on improved clinical outcomes, enhanced engagement and reduced costs. The ICM program uses predictive modeling tools that proactively identify gaps in care, incorporates evidence-based clinical care strategies, and employs a multi-disciplined Personal Care Team to address the needs of the whole person versus just a specific condition or health issue.
ICM will be included with fully insured commercial medical products starting Jan. 1, 2012.
- Groups sized 1+, with effective dates prior to Jan. 1, 2012, will continue to receive the current suite of care management programs until the 2012 contract renewal date.
- Individual members will transition from the current suite of care management programs to ICM on Jan. 1, 2012, regardless of policy effective date.
Care Enhance (our 24 Hour Nurseline) and the Regence Rare Disease Condition Management Program will continue to be included for fully-insured group and Individual customers. The ICM program will have no impact on these programs.
Members who are actively participating in a care plan through one of our current medical management programs will continue to be supported until such time as it is appropriate to close the case.
Members receiving more passive interventions (i.e. newsletters without active intervention from a case manager), will receive a communication about the program change and sources for additional information/support outside of the ICM program — newsletters and health-related programs available through myRegence.com, for example.
ICM availability for self-funded groups and Medicare members is currently slated for Jan. 1, 2013.
New collateral has been created for your use. Feel free to use the 100+ group pre-sale piece, member piece and workplace poster to promote this new option. ICM pre-sale information for small groups will be integrated into product flyers that should be available by early November.
If you have any questions, please contact your Regence sales executive.
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