Utilization Review/Case Management
At
Maxon, we approach Utilization Review/Case Management somewhat differently
than most organizations providing similar services. Instead of making
the process adversarial, Maxon brings the patient into the process as
early as possible to make it as cooperative as possible. We have found
that patients appreciate being consulted and are made to feel that the
plan is working for them instead of just trying to save money. Maxon,
in a real sense, becomes a patient advisor while the plan realizes the
benefits of cost containment.
Pre-Certification involves screening non-emergency hospitalizations against established medical norms, and the review of emergency admissions for appropriateness of treatment.
Utilization Review monitors continued treatment to discharge after admission has occurred, to determine the necessity of continued in-patient care. The benefits to the employer and plan participants are cost-containment and quality assurance.
Case Management is designed to reduce acute care in-patient stays and promote continued use of alternative health care delivery services. This is achieved through early identification of hospitalizations where alternative service(s) can provide appropriate care at substantial savings.