MANAGED CARE CONCEPTS, INC. A Full Service Managed Care

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MANAGED CARE CONCEPTS, INC.

• A Full Service Managed Care Company

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MANAGED CARE CONCEPTS, INC., PROVIDES

• Pre-Certification
• Utilization Review
• Discharge Planning
• Retrospective Review
• Large Case Management
• Disease Management
• Fully Integrated Wellness Program
• 24 Hour Nurse-on-Call

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• Other Cost Containment Services
• Centers of Excellence for Organ Transplants
• Claim Negotiations
• Peer Reviews/Appeals
• Medical Necessity Reviews
• Hospital Bill Audits
• Maternity Management Program
• Outpatient Psychiatric and Chemical
• Dependency Management Program
• Workers Compensation Management Program

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PHILOSOPHY

• At Managed Care Concepts, Inc., we believe by
  acting as patient advocates and treating people
  with honesty and respect, we can build the trust
  and cooperation necessary to accomplish
  successful, cost-effective resolutions. We focus
  on combining patient satisfaction with quality
  outcomes, while working to minimize costs for the
  payer.

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NATIONAL ACCREDITATIONS

• URAC Case Management Accreditation
• Met the quality standards for the healthcare
  industry.
• Earned a score of 100!
• Core Standard for Utilization Review

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LARGE CASE MANAGEMENT

• Situations where Large Case Management can effect
  cost savings while enhancing appropriate care
  are
• Repeated in-patient admissions, excessive length
  of stay, frequent treatment
• Potentially large dollar claims
• Chronic or progressive disease
• Opportunity to transfer a patient to a facility
  offering an appropriate level of care more cost
  effective
• Lack of qualified caregivers in the home setting

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LARGE CASE MANAGEMENT

• Multiple diagnoses
• Acute or sub acute rehabilitation of physical,
  speech, or occupational therapies
• IV therapy or peritoneal nutrition
• Severe injuries
• Durable medical equipment needs
• This list is not all-inclusive. Any apparent
  long-term illness can be considered a candidate
  for Large Case Management
• MCC, Inc. offers Active Case Management and
  Passive Monitoring

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ULTIMATE GOALS OF DISEASE MANAGEMENT

• Integration of care
• Eliminate duplication of services to help
  conserve benefit plan dollars
• Making physicians accountable
• The higher the compliance rate, the healthier the
  employee.
• The better the outcomes, the greater the cost
  savings to the employers plan.

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WELLNESS PROGRAM

• Our standard program includes
• Health Risk Assessment and Reports
• Biometric Measurement
• Lifestyle Risk Profile Report
• Corporate Reports
• Wellness Coaching Program
• Coaching for identified at risk participants

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CENTERS FOR EXCELLENCE FOR TRANSPLANTS

• Clients can contract for global fees (case rates)
  for the actual transplant
• Discounts for pre- and post- transplant care for
  up to one year after the transplant
• The employer limits his liability and is able to
  predict and project the costs for his potentially
  high dollar transplant claims.

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24 HOUR NURSE ON-CALL

• Members may talk to a RN 24 hours a day about any
  medical or healthcare concern.
• Offers members toll-free telephone access to
  experienced RNs 24/7, 365 days a year.
• Our nurses are an immediate, reliable, and caring
  source of health and medical information,
  education, and support.

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OUPATIENT PSYCHIATRIC AND CHEMICAL DEPENDENCY
MANAGEMENT PROGRAM

• Registered Nurses are available to discuss
  treatment options and facilitate referrals to
  appropriate providers.
• Our nurses will also identify the more complex
  cases, which may require the more active
  involvement of a Case Manager.

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COST CONTAINMENT

• Review Services
• Investigate questionable and complex claims
  involving
• Reasonable and customary fees
• Over-utilization
• Medical necessity
• Pre-existing conditions

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OTHER COST CONTAINMENT SERVICES

• Hospital Bill Audits
• Pre-screens bill to determine if audit is
  necessary
• Determine if amount of discrepancies will offset
  cost of audit
• If audit is appropriate, onsite review of medical
  records is performed by RN
• All billed services are compared against
  physicians orders and validated for accuracy of
  billing
• Medical necessity is evaluated
• In case of questionable services, referral is
  made to physician review

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COST CONTAINMENT

• Negotiations
• If pre-screen indicates that bill is not good
  candidate for audit, MCC, Inc. will contact the
  hospital to attempt to negotiate a prompt pay
  discount in lieu of audit
• We will also try to negotiate large physicians
  bills and in-patient bills when no availability
  of a P.P.O network