How We Help // Care Management

Specialty Case Management

We control healthcare costs while improving member outcomes for the toughest cases.

Members who become ill with complex health conditions can be very challenging. Navigating treatment plans for these conditions can be overwhelming for members and the costs can be financially catastrophic for plan sponsors. HealthSmart Care Management Solutions has developed proprietary and innovative clinical solutions to help manage some of the most challenging health cases.

HealthSmart Specialty Case ManagementThere is truly no other suite of programs like those offered by HealthSmart Care Management Solutions. We provide fully integrated, comprehensive solutions so our clients can provide quality healthcare while stretching their healthcare dollars. With our Specialty Case Management solutions, we save our clients millions of dollars while advocating for our members with challenging health issues. 

Our proprietary Specialty Case Management solutions include: 

Cancer
Our Cancer Case Management program coordinates all aspects of cancer care from initial evaluation and approval of treatment protocols to coordinating multiple provider treatment plans. We incorporate nursing, nutrition management and pharmacy management to guide the member through the healthcare continuum. 

Chronic Kidney Disease
Our Chronic Kidney Disease program addresses the risks associated with chronic renal failure. The program takes a holistic approach in addressing a member's complications and comorbidities in conjunction with stages 3 to 5 renal failure. The program coordinates all aspects of care from the approval of treatment protocols to coordinating multiple provider treatment plans. We incorporate nursing, nutrition management and pharmacy management to reduce avoidable complications and stall progression of the disease. 

Dialysis
A single member on dialysis is likely to result in catastrophic costs to a plan sponsor. Our program is designed to combat the high costs of dialysis with proven plan designs, case management, claims repricing and appeal assistance.

Diabetes
This proprietary 6-week course is specifically tailored for members with type 1 and type 2 diabetes using the “teach-back” methodology. Weekly assignments are given so instructors can ensure and confirm that the concepts are received and understood. Classes are available weekly in the evenings, and can be accessed from any location in a webinar setting.

Transplants
Our Transplant Case Management program helps members navigate through the entire organ transplant process to ensure they receive the best care and support while providing a mechanism to control the costs associated with organ transplantation.The program provides end-to-end case management from the initial evaluation through post-transplant care. It provides access to national centers of excellence for all types of organ transplants and a dedicated team of case management experts, including registered nurses, dietitians, and PharmDs.

High Cost Drug Management
Our High Cost Drug Management program addresses the skyrocketing costs of high-cost specialty prescription drugs by leveraging utilization oversight with strategies and targeted programs to deliver big discounts. This program curbs spending on high-cost specialty prescription drugs through focused pre-authorization, specialty pharmacy cost negotiation, voluntary co-pay assistance program fulfillment, and rebates.