Medical Management

HealthEZ offers a comprehensive suite of medical management services. All services are provided by our own staff in our Bloomington office, and no services are sub-contracted.

Members can access these services, including our 24-hour nurse line, by calling their custom phone number.

Utilization Management

This service provides close monitoring of inpatient hospital admissions, certain outpatient procedures and review requests for medical necessity.

Case Management

Nurse case managers assist with complex medical and behavioral problems. They support and educate in diagnosis and treatment, and act as a resource for questions or concerns. Case management cases are usually complex cases, such as cancer of any type, cardiac disease, transplant cases, and mental health / substance abuse cases.

Maternity Management

A high-risk assessment is completed with each pregnant woman who participates in the program. The goal for this program is to get a healthy full-term baby for the parents and save money for the employer and employee.

Disease Management

Employees with conditions such as asthma, diabetes, or heart disease will have the opportunity to participate in our disease management program. Our nurses provide comprehensive literature and other education. Our goal is to keep these diseases from progressing further to the point of complications. Our objective is to help employees restore their own health as best we can.

24-Hour Nurseline

Employees have 24-hour access to a nurse who can answer questions about childhood or minor illnesses, medication safety, and other basic medical issues.

Case management: better outcomes while saving money

Case Study 1: SAVINGS = $268,228

Patient Summary: A 7-year-old child with brain damage from anoxia after choking on a foreign object. Patient was ventilator dependent and the prior carrier was approving payment for home health care, which was provided by a parent and rotating nurses. When this case transitioned to HealthEZ, we reviewed the home health care billings and found that the plan had been paying for 24/7 care that included custodial care, housekeeping and other non-medical related duties. The carrier was also paying the parent and paying a retail rate to the home health nurses.

Case Management intervention: The HealthEZ medical management team coordinated home care services through Medicaid funding in the patient’s home state – which had been available previously – thereby reducing home health care service from 24 to 12 hrs per day; this was covered by the employer’s health plan. We converted medical equipment that had been rented for multiple years by the prior carrier into a purchase at no cost. We also negotiated the hourly fee for the home health nurses to a lower rate and discontinued paying the parent.

Case Study 2: SAVINGS = $85,599

Patient Summary: A 28-year-old female was pregnant with twins at 18 weeks gestation. The patient was diagnosed with the rare Twin to Twin Transfusion Syndrome, a condition whereby identical twins share the same placenta. The prior carrier required the patient to be hospitalized and on bed rest due to her high risk condition. The patient had a 7-year-old daughter at home with no outside help and was not following the carrier’s instructions, causing her further risk. The carrier presented an option to the patient to terminate one of the twins, however this procedure puts the other twin at great risk for preterm birth and neurological disorders.

Case Management intervention: HealthEZ became involved when the plan changed, and we were able to provide in-home monitoring so the patient could be at home for her daughter before and after school. We also presented an alternative option, which was to perform a procedure that reduces the amount of amniotic fluid. The physician and patient determined the best option was to proceed with a Selective Laser Photo Coagulation of the communicating vessels. Only 2 facilitites in the country perform this procedure, and working with the employer we were able to pay for travel costs so the patient could go to an out-of-state facility to undergo the procedure. The patient delivered both babies; one very strong and the other who was at a less than ideal weight but able to survive.