All of our the medical management functions are fully integrated to achieve a “Value-Based” program under our Mission Control Operation. We named our operation Mission Control because our medical staff manages the navigation of care from the beginning to the end based on physician outcome information. Our mission is to get the best outcome on every case.
Medical Advocate Program® (“MAP®): When a participant speaks to a MAP® Nurse Advocate, more than 40% of the time, the Nurse Advocate provides a different direction. It is shocking but true — all too often the participant’s self-diagnosis or medical need may have been incorrectly identified. Based on the participant’s location and medical needs, our Nurse Advocate and Research Analyst identify the top 5% to 10% of providers in the community. Through this unique approach, only 15% to 20% of physicians nationwide meet our MAP® criteria. While that means 80% to 85% of physicians do not make the cut, it also means our participants get the very best medical care. MAP® can assist with any type of medical care: primary care, specialist services, mental health, diagnostic tests, and second opinions. learn more »
MAP® Rx: Our medical staff reviews the participant’s prescriptions to determine if they are taking the correct medications at the most cost-effective prices. Our program can save participants money on thousands of name-brand and generic medications. We work with leading pharmaceutical companies to provide affordable solutions such as patient assistance programs, grants and other alternative resources.. learn more »
UM/Precertification: In addition to providing medical necessity review, the program is integrated with MAP® to ensure participants make informed decisions about their medical care. We speak directly with the participant on every medical precertification. Through our medical review process, we also determine if the participant needs case management or the MAP® Rx program for prescription medication review.. learn more »
MAP® Case Management: When a participant faces a serious illness, a Certified Case Manager (CCM) works directly with them and their family to ensure they understand how to navigate the healthcare system to achieve the best outcomes. Our resources include CCM Nurses, Research Analysts, Pharmacy Professionals, and Medical Directors. learn more »
Direct Pay: This is a proactive, coordinated payment to physicians and facilities at or before the time of service. It is a different and efficient way of paying providers. The bundled payment saves the participant money and eliminates any balance billing issues. This program allows an employer to customize the plan benefit design to encourage participant engagement with MAP® to make wise healthcare decisions financially (price) and outcome-based (quality). Price + Quality = Value. A plan benefit design discussion can help employers understand the pros and cons of adding a “physician only” medical network.
Note: We have the ability to perform provider negotiation under a single payer agreement or a direct contract between the employer and provider.