eNEWSLETTER
Volume One, Issue 1
- CareAssist's New Comprehensive High Risk Maternity Management Program
- CareAssist and ClinAssist Work Together for Optimal Outcomes
CareAssist's New Comprehensive High Risk Maternity Management Program
Coordinates Care for At-Risk Pregnant Women and Improves Birth Outcomes While Reducing Payer Costs
The Assist Group recently unveiled a new, next generation disease management solution aimed at improving outcomes and reducing the cost of high risk pregnancies. Part of our highly effective CareAssist service, the new program provides clinical and financial oversight for women with high risk pregnancies, creating a complete outcome-driven care management plan.
Beverly White Freedman, President and CEO of The Assist Group says that the program comes in response to a need expressed by our existing customers, many of whom were looking for a prenatal management program that could replicate the value of CareAssist's NICU services. "We are demonstrating that by providing comprehensive care management during the pregnancy, we can both optimize outcomes for mother and child, and minimize the expense by improving the quality and continuity of care," says Freedman.
More than one-third of all pregnant women develop complications annually, at a total cost of $1 billion, and many have identifiable risk factors that triple the risk of NICU admission, like multiple pregnancy, past history of pre-term delivery, uterine and/or cervical abnormalities, high blood pressure, diabetes, obesity or other chronic health problems. By targeting these factors, the high risk maternity management program can anticipate possible complications and introduce evidence-based interventions that result in mitigation, improved outcomes, and reduced pregnancy and NICU costs. Based on current studies, an ROI of at least three to one can be expected with appropriate treatment.
Here's how it works: Once the less than five percent of women with extreme issues are identified, CareAssist's care management team, including specialists in maternal fetal medicine (MFM), begins working with the mother's treating team to optimize care during the pregnancy. Some of the country's leading physicians, as well as perinatal nurse case managers and patient educators construct a customized care management plan for each patient.
An MFM specialist reviews the case as the pregnancy progresses, following up with the patient's healthcare provider. When the patient delivers, the client receives a detailed outcome report, including costs, clinical outcomes and any necessary recommendations for NICU care management.
Other benefits include education and resources to help families prepare for optimal birth outcomes and facilitate a safe and timely discharge for mother and child.
For more information, please visit our website at www.assistgroup.com or call 877-631-9080.
CareAssist and ClinAssist Work Together for Optimal Outcomes
Fully Integrated Disease Management and Claims Resolution Services
Case Study: Baby Jack
Issues: Left Diaphragmatic Hernia, Sepsis, Cardiac Arrest, Seizure Activity, Diffuse Brain Atrophy
Results: 15 Percent Reduction in the Forecasted Length of Stay and a 22 Reduction in Billed Charges
Baby Jack was hospitalized with a left diaphragmatic hernia when his case was referred to CareAssist on day of life 33. His abdominal organs, as well as his large and small bowel, had pushed into his chest cavity, compressing his lungs and impeding their development.
CareAssist's neonatologist assigned to the case, a leading expert on respiratory care, worked with the baby's treating team to devise a respiratory care plan specifically tailored to help Baby Jack's underdeveloped left lung. Our expert physician reviewed Baby Jack's case and recommended aggressive ventilator weaning, medication to decrease pulmonary congestion and family education. As Baby Jack's condition steadily improved, a timely teaching regimen prepared the family to take the baby home on a ventilator.
Then, late in his hospitalization, Baby Jack developed sepsis. The infant suffered a full cardiac arrest and showed signs of seizure activity after receiving CPR. CareAssist's neonatologist recommended an early evaluation of Baby Jack's neurological status. Unfortunately, the treating team changed weekly and Baby Jack never received the necessary studies to determine his demeanor. At this point, our neonatologist reminded the treating team about the evaluation and Baby Jack received multiple studies within the next week. Tests determined that Baby Jack was suffering from diffuse brain atrophy and decreased function.
In collaboration with Jack's doctors, the CareAssist neonatologist arranged a care conference for Jack's family to thoroughly evaluate the baby's quality of life. After weighing their options with the help of the team, the family decided to continue all life saving measures for Jack.
After 170 days of hospitalization, Baby Jack was healthy enough to go home with his family. His discharge was a full 28 days earlier than anticipated based on similar birth weights and gestational ages. CareAssist's unparalleled clinical and financial management had assured continuity and appropriate acceleration of care, resolved key issues, and introduced innovative evidence-based solutions. CareAssist's involvement in this case achieved a 15 percent reduction from the forecasted length of stay, resulting in a savings to the payer of $223,400.
But our involvement didn't stop there. Baby Jack spent a total of more than 170 days in the hospital at an average cost of almost $10,000 per day. In light of the extraordinarily high charges, the CareAssist nurse care manager who conducted the customary financial review of the case recommended a ClinAssist Forensic Review to the payer. The Forensic Review was able to identify experimental charges that were not disclosed during the care management oversight process, incorrect levels of acuity and unbundled services. The Forensic Review resulted in a 22 percent reduction in billed charges, a savings to the client of $307,000.
In the end, our integrated disease management and claims resolution services saved the client a grand total of $530,400.