Part 2: Multifaceted Approach to Manage Utilization
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In Part 1 of this blog series, we looked at utilization management (UM) within a PACE environment and why it is critical to reduce costs – both monetarily and for the health and wellbeing of participants. Today in Part 2, we will look at the multifaceted approach that Intus Care uses with our PACE partners to reduce costs to the bottom line as well as support the overall health and wellbeing of participants in the long term.
At Intus Care, our strategy is to ensure the right access to the right care at the right time and in the right location. We work with programs to ensure their participants receive high-quality care and services while also managing their service authorization and payment process to align with the needed care. This includes a multifaceted strategy to recognize and manage symptoms early enough to intervene and prevent an ED visit. Secondly, if a participant does visit the ED, there are strategies to still manage the event, finding ways to reduce their time in the hospital to prevent its negative effects. The PACE team can work together with the hospitalists to inform the treatment plan and advocate for discharge, knowing the participant has a layer of support to transition home through the PACE program.
There is a sweet spot in UM. Intus Care uses a data-driven approach with our partners, coupled with what their care teams are seeing in real-life to try to find that sweet spot. We work collaboratively with the interdisciplinary team and clinical staff to identify subtle changes in participants' health, such as signs of infection, increasing confusion, and weight changes. By monitoring these changes and taking proactive measures such as phone calls, hands-on visits, or bringing participants into the clinic, we can address concerns before they escalate.
Another critical aspect of proactive utilization management is recognizing changes in a participant's social network or informal caregiving situation. These changes can lead to instability and potential hospitalization. By identifying and addressing these risks early, we can disrupt the cascade of events leading to hospitalization.
Intus Care is uniquely positioned to help PACE programs succeed in their UM strategies. We have a team of experienced PACE professionals who have worked within and across PACE organizations and managed care organizations across the country. Recently, we announced the availability of Delegated UM services for PACE, a first-of-its-kind fractionally-staffed Integrated Care Services (ICS) clinicians and nurses who optimize utilization management for organizations. Read the press release to learn more about this service.
In conclusion, proactive utilization management is crucial to achieving the best outcomes for older adults. By focusing on prevention, early intervention, and coordinated care, we can improve the quality of life for our participants while effectively managing costs. Through our commitment to these principles, we aim to set the standard for high-quality care and support for older adults.
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