Cost Containment
Cost Containment
BMA provides the programs you need to take control of healthcare costs.
Cost Containment
Cost Containment is sometimes known as disease management or case management. It is designed to support people with high risk chronic conditions such as:
- Diabetes
- Congestive Heart Failure
- Coronary Artery Disease
- Asthma
- Chronic Obstructive Pulmonary Disease
Our program uses registered nurse specialists communicate with participants on their level. Care is coordinated among nurses, physicians and ancillary service providers.
Utilization Review
Utilization review is designed to stop high cost claims before they start. By taking an proactive role in patient care, BMA ensures that the employee care is done in a way that mitigates high claims.
Utilization review services include:
- Pre-certification healthcare services based on medical necessity and appropriateness of care.
- Prospective, concurrent and retrospective review
- Discharge planning
- Analysis of paid claims data to identify
- At-risk claimants
- Opportunities for proactive cost containment
- Outpatient – re-admittance within 30 days
BMA leverages daily pre-certification activity reports to proactively address high cost claims. Also, our technology immediately identifies and notifies us about high-risk “red flag” triggers such as:
- AIDS
- Amputations
- Asthma
- Blood Disorders
- Burns
- CAD/COPD
- ICU Stays
- Possible Subrogation
- Inpatient - 7 days or more
- Outpatient – multiple procedures within 14 days
- Outpatient – re-admittance within 30 days
