DBMS now provides the
full service of individual and
group care management.
This is an add-on optional
module that helps identify members who are at
risk for diseases. Case Management will assist
you and your case managers with education,
monitoring, and active management of your
at-risk population. Care plans that are designed
to achieve a specific outcome provide standard sets of services and assessments.
These services and assessments are provided to patients
based on their individualized health
Case Management tracks the progress
of members under report
variances from the Care
Plans. You can identify your case
management population through various portals.
These portals include claims analysis,
authorization analysis, and recommendations
calling for primary or specialty care providers
Health Risk Surveys. You can define the level of
case management through assessments. Or,
scores from the assessments will highlight the
level of necessary case management. Monitoring is
accomplished by comparing claims paid and
authorizations issued with services identified
in care plans. Case Management uses interactive
visual cues to indicate overdue services.