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Care Management
TribalCARE Care Managment Solution offers an integrated, comprehensive portfolio of quality care management products and services, which enable our clients to provide appropriate and cost-effective healthcare for their entire population — those healthy individuals who need to stay that way, those at risk who need to improve their health and those who need to effectively manage their chronic conditions such as diabetes and asthma.
Outcome-based Population Health Management
A full spectrum of services is available through one source as a fully-integrated set of solutions with robust cross-referrals and a combined data repository that measures outcomes and return on investment across the entire care continuum. Our solutions provide intervention models, clinical expertise, and an array of flexible and scalable program elements that make sense to Tribal organizations and that are designed to minimize costs, improve organizational efficiencies and improve the health and productivity of members.
360-Degree Care Management:
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Case Management
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Our Case Managers are professional Registered Nurses with at least 5 years of clinical experience and are designed to help meet quality and cost containment goals, as well as assist members in times of serious illness when complex care is required.
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Disease Management and Predictive Modeling
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We incorporate a two-part process to positively affect outcomes of high-risk populations. First we use Predictive Modeling from several data sources (including medical and prescription claims data) to identify members who are at highest risk for future healthcare costs. Once at-risk members are identified, our Disease Management services come into play and provide innovative, proactive methods of supporting members. This program helps those that suffer from chronic conditions such as diabetes, heart disease, asthma, depression and chronic obstructive pulmonary disease (COPD).
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Utilization Management
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The program is designed for employers and providers to ensure optimal, cost effective outcomes while maintaining a focus on nationally accepted criteria for quality care for both inpatient and outpatient services.
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Maternity Management
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The Mother and Child Program helps expectant mothers with potential risk factors take measures to ensure a healthy delivery and a healthy baby.
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Wellness Assessments
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Interactive online health assessments help members determine personal risk factors and develop strategies for taking control of their health.
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Wellness Coach Programs
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The Wellness Coach Program takes members through a 12-week course to better health with relevant health topics, worksheets and assignments. Wellness Coach Programs focus on the following increase exercise, improve nutrition, lower blood pressure, improve cholesterol, stop smoking and manage stress.
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Precertification
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Highly-qualified clinical professionals evaluate medical treatment plans for medical necessity and appropriateness of specific medical care before the care takes place.
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