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Utilization Management
The StarPoint Utilization Management team reviews the patient’s medical history and assesses the proposed care for appropriateness. Our detailed review and the use of nationally recognized criteria by Milliman USA, promotes cost savings by evaluating the appropriateness, medical need and efficiency of health care services, procedures and facilities. Each review is also an opportunity to identify high-risk individuals who may benefit from case management.
Case Management
StarPoint’s Case Management team identifies at-risk individuals who would benefit from case management. Each individual is assigned a StarPoint Case Manager who works with the individual until the case is resolved. The nurse’s approach is one of partnership with the member, provider, facility, and Plan Sponsor.
One of the unique aspects of our case management service is that StarPoint devotes great effort, not only toward management of the medical needs of the individual members but also toward management of the financial risk that exists for the groups we serve. We have a dedicated Risk Management Task Force made up of representatives from Claims, Stop Loss and Case Management. Together this team is responsible for coordinating and communicating the issues surrounding our clients' high-risk cases. In addition, cases identified as potential high risk are assigned to the Risk Management Agenda. Representatives from Claims, Marketing, Stop Loss, Administration and the individual Case Managers meet once a week to discuss health and cost concerns for these individuals. Collectively, this team works to manage high risk/high dollar cases, keep groups informed of their financial risk, and assure that Stop Loss carriers are informed and that there are no surprises for anyone, including the member.
Chronic Care
StarPoint provides an enhanced innovative Disease Management and Wellness Program. These programs consist of specific care strategies based on current best-practice clinical knowledge. We promote an active treatment plan and a patient’s compliance with that plan.
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StarBaby Maternity Management
StarBaby is a specific program that was developed to help prevent maternity complications and pre-term deliveries. We strive to reach all pregnant women within the first trimester of pregnancy to identify women who are at-risk. Our experienced maternity case managers provide support through consultation, education, and support throughout the participant’s pregnancy.
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