by Josef Duell
Manager, Cost Containment
Stop Loss Department
HM Insurance Group

Excess risk insurers must find the delicate balance between ensuring the appropriate treatment of patients and containing the expenses involved in medical care. As healthcare costs continue to rise, it is of particular importance to closely watch the charges on the catastrophic claims related to stop loss insurance. There are trends toward hidden expenses and rising fees, all of which may be mitigated better by employing additional medical management techniques.

by Dale Sharp
NOVARE LLC

During the Viet Nam War, nurses often had no terms for the operations required to save lives. They coined the term “horriblectomies” for the life-saving operations where so much had to be taken out or removed (Marshall, 1987).

by Jennifer B. Meko, MD
Western Region Medical Director
MedSolutions

With growing pressures to reduce healthcare costs and maintain quality, medical management companies now offer multiple solutions that include case management, disease management and utilization management services. These care management portfolios are designed to drive patient behavioral health changes, promote physician compliance with evidenced based guidelines, and introduce controls that will drive not only appropriate utilization of services but also quality care.

Coalition America, Inc. (CAI) offers significant savings on transplant services through its relationship with national transplant networks. Clients are eligible for average savings of 30-50% on transplant services, including pre- and post-transplant care. Most transplants are based on case rates, and the pre-transplant services are at significant discounts.