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RCI introduces the Dependent Eligibility Audit
Did you know that 5-15% of all dependents are ineligible and can be costing as much as $3,000 per dependent?  RCI can provide a dependent eligibility audit and provide a substantial savings for your self funded health plan.  Talk to your sales or account representative to receive a proposal.

Midland’s Premier Network
RCI is excited to announce the new Premier Midlands Choice Product.  Contact your Sales Representative or Account Manager for more information.
 


When Regional Care started in the business, medical management was focused on potential higher cost claims and managing the 5% of a covered population that represented 50% of a Plan’s cost.  Through the years our experience has shown

that “proactive” programs that address the other 50% of cost also positively impact participant satisfaction.  We offer a wide array of medical management programs that can be used separately or fully-integrated.  These include:

Wellness and Prevention:  Participants have access to a user-friendly and effective self-care and prevention web site that features a health risk assessment, self-care guidelines, an integrated patient health record, medical and prescription drug information and evidence-based treatment evaluations.  This program also features an integrated 24/365 nurse line and automated distribution of reminders and health hints.

Health Coaching:  Participants can call or request a call from health coaches that can assist them with gaining a greater understanding of managing health conditions or gain assistance with weight loss, smoking cessation or other healthy behaviors.

Disease Management/Compliance Management:  Using sophisticated data mining and predictive modeling tools we can identify patients that are at risk for more serious conditions due to one or more diagnoses and/or failure to comply with the treatments for their conditions.  Once identified, those at risk can be managed through a range of approaches including correspondence, educational materials, outbound calls and more comprehensive counseling.

Precertification:   Traditional management of hospital admissions has been supplemented with prospective review of ambulatory surgery, high cost diagnostic tests, medical equipment and other targeted procedures and services. 

Case Management:  Patients with severe and costly conditions are handled by Case Managers that monitor treatment plans for opportunities to improve care and reduce cost.  Efforts are made to involve the family and to maintain the continuity of care among the multiple providers typically involved.  The Case Managers also coordinate transition care as well as educating the family on community resources that may be available.

Focused Condition Management:  Several programs are available to manage conditions that significantly impact cost, including cancer, end-stage renal disease and any condition where specialty drugs are used.

While every program may not be feasible for every employer we know that the tools must be available to take every opportunity to gain a healthy and productive workforce.

 

 

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