UTILIZATION MANAGEMENT PROGRAM
MEDICAL CASE MANAGEMENT PROGRAM
CHRONIC DISEASE MANAGEMENT PROGRAM
HEALTH WELLNESS & SUPPORT PROGRAM
EXPECTRUM: SRS' PRENATAL WELLNESS PROGRAM
MEDICAL CASE MANAGEMENT
 | SRS Philosophy |
Both employees/insured and attending physicians must be comfortable and satisfied with the quality of care offered. However, SRS maintains the approach that creative planning can result in the extension of health care dollars.
Wendy Theobald, LVN
Medical Case ManagerMedical Case Management (MCM) is provided by SRS Medical Case Managers, all of whom are registered nurses with special MCM training. In addition, a national network of 50 professionals with expertise in acute, chronic and home care as well as reimbursement is available. MCM professionals act as advocates for the employee/insured through the multi-level health care system.
| Assessment |
Case Managers conduct initial screenings to assess the potential for moving the insured through the health care system. Following a determination that the patient would benefit from Medical Case Management, initial reports for the claims payor or client is generated. Reports usually include past medical history of the individual, present status, plan of treatment by the attending physician and appropriate providers.
| Reporting |
SRS provides a variety of management reports including initial assessment with appropriate alternative care, monthly interim reports and final reports. Our sample reports give you a look at the information we provide.
 Debbie Mikus, LVN, Medical Case Manager |
| Case Management Selection |
Since our founding in 1990, we have provided clients with diagnoses, injuries and cost parameters requiring alternative case services including:
Premature Labor Premature Birth Congenital Anomalies Spinal Cord Injuries Head Trauma Multiple Fractures Burns Amputations AIDS/HIV
Stroke Malignancies Cardiac Condition Respiratory Insufficiency Apnea Hypoventilation Syndrome Renal Failure Neuromuscular Disease Organ Transplant
| High Risk Pregnancy & Management Program |
Complex pregnancies, labor and delivery are exerting serious financial pressures on benefit plans. In a given year, the costs of complicated prenatal and birth care can cost plans $300,000 or more. Premature births and low birth-weight births often revolve around high risk factors, which greatly stress new parents and run into the millions of dollars.
This new service calls for SRS Prenatal Risk Assessment Reviewers trained in pregnancy and delivery issues to work with expectant mothers early in a pregnancy and takes them through SRS’s Start Right screening program. An expectant mother’s clinical history will be compared against the SRS list of high risk factors.
High risk factors will establish a cause for reviewers to contact the insurer to request Prenatal Case Management. In this scenario, SRS healthcare staff members act as a patient resource, coordinating care of patient in conjunction with the attending obstetrician and to assure that all cost-effective and appropriate measures are taken to support a healthy delivery. For those women whose pregnancies are not considered high risk, reviewers will pre-certify the hospital admission and follow the case to delivery.
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