Proactively Addressing Member Concerns

Medicus Resource Management has developed and implemented processes designed to help assure member satisfaction and to assist members in avoiding unnecessary problems. The guidelines which Medicus staff adhere to, are as follows:

• Staff members inform in writing every patient, physician, and facility concerning precertification, and continue to work proactively to keep all channels of communication open.
• Staff provides ongoing reporting to help keep everyone “in the loop,” including providers, members, insurers and re-insurers.
• The Medicus large-case management program promotes wellness, prevention of complications, access to appropriate providers and services, and encourages member compliance with medical regimens. These services are meant to assist members with complex problems and to help them achieve an excellent quality of life.
• Members and their families are regularly informed of topics relating to a member's care. Care plans for both current and future needs are set up and thoroughly explained to all involved.
• Members are contacted to update or review established plans, as indicated. Member and physician education is provided, especially when a case involves referrals, tertiary care, or high-dollar medication procurement.
• A member's health problem that may benefit from services not typically covered by a particular plan are identified, with discussion following between the Case Manager, member, and provider. This occurs before the member’s insurer/employer are contacted and given a recommendation for coverage as a care measure. Providing a relatively inexpensive benefit exception often prevents large expenses in the future.