OUR MISSION
"Nursing is an Art: and if it is to be an Art, it Requires an Exclusive Devotion as Hard a
Preparation as any Painter’s or Sculptor’s Work"
~ Florence Nightingale
Another Florence Nightingale saying is, “Let us never consider ourselves finished nurses . . . . We must be learning all of our lives.” This bit of wisdom from Florence Nightingale exemplifies the quality of the licensed medical professionals employed by CaseMed Solutions and by extension, InsurHealth Affinity Group’s professional resources, offered to our customers.
CaseMed believes that to provide appropriate Holistic Healthcare Case Management services, that sometimes, assigning a professional team of resources will best serve the patient client and his/her employer or other affected party. CaseMed will discuss this on a case by case basis with its customers, if it appears that utilizing a team approach is a best practice for the customer to help rehabilitate the Injured Patient client.
Our Holistic Healthcare Case Management Mission is a total focus on the Interconnected Body, Mind, and Spiritual capacity of the injured patient followed by responsible Coordination of Care.
“The cure of the part should not be attempted without the cure of the whole.” ~ Plato
NURSE CASE MANAGEMENT
CaseMed Nurse Case Managers work in the field or telephonically on behalf of our claims and self-insured customers facilitating professional analysis of the injuries sustained by our customers patient employees or related personnel, particularly those individuals with catastrophic and multiple trauma injuries. Our mission is to report on the injuries, rehabilitation needs and recommended of continued coordination of care for best outcomes for our customers and their Injured Patients.
MEDICAL-LEGAL CASE MANAGEMENT
Medical-Legal Case Managers perform the same activities as Nurse Case Managers but with special emphasis on potential litigation discussions between Personal Injury Attorneys (Plaintiff Counsel) representing the patient client and Defense Counsel. Typically, our Medical-Legal Case Managers are also Paralegals or Attorneys. CaseMed does not take sides in these situations. Rather we focus on developing a “reasonable” fact-based Life Care Plan to facilitate conversations and avoid going to trial.
LEGACY CLAIMS
CaseMed, with our National Alliance with a Global Reinsurance Broker, can help claims organizations to reduce their aged claims books and associated liabilities. Alternatively, this alliance enables our claims customers to buy or sell their legacy claims to other parties, including Captives and Risk Retention Groups based on their business objectives. CaseMed plays a role in legacy claims by integrating CaseMed Nurse Case Managers, InsurHealth Affinity Group case management members, Medical-Legal Solutions, Arcadia and other CaseMed or InsurHealth alliance partners. In some cases, the legacy claims owner will activate closed catastrophic claims for reassessment of the healthcare needs through the support of case management assessments.
SOCIAL WORKERS & INTEGRATIVE PSYCHOLOGY
Part of our holistic approach to Client Patient care includes using licensed Social Workers and Integrative Psychologists to address the mind and spiritual capacities of the Injured Patient. This can be the assemblance of a Case Manager, Social Worker and Psychologist. It can also be applying the same to the Client Patient’s home, family or potentially substance abuse situation. Integrative Psychology utilizes a holistic set of therapies focusing in an integrated way of helping the individual with the totality of their body, mind and spiritual needs. When CaseMed can match a Social Worker and Integrative Psychologist as a result of the outcomes of a case management assessment, this Social Worker and Psychologist team can improve the individual Patient Clients understanding of themselves and improve their behaviors through a variety of therapies addressing the Injured Patient’s condition. For more information on Integrative Psychology, click on the following link: Integrative Therapy | Psychology Today.
LIFE CARE PLAN MANAGEMENT
Holistic Life Care Plans focus on the Injured Patient from the following lens: Body-Mind-Spiritual Rehabilitation needs and length of the rehabilitation timeframe; Loss of Income; and possibly Minor Children needs during the Injured Patient’s rehabilitation timeframe. Additionally, we recommend involving two CaseMed alliance partners that can help law firms and Injured Patient’s settlement: One is Medical-Legal Solutions that works with CaseMed on claims activities with Artificial Intelligence (AI) and Machine Learning (ML) data analytics that balances the Life Care Plans rehabilitation needs and costs for the Injured Patient’s Settlement. Two: Arcadia, a leading Structured Settlements broker to assist the parties for the final Settlement agreement that enables the Insured Patient to lengthen his/her share of the Settlement through cash and investments. More on Medical-Legal Solutions (Medical Data Analytics) and Arcadia (Structured Settlements) below.
MEDICAL CASE ANALYSIS AND ESTIMATES
From time to time CaseMed is asked to project the costs of urgent medically necessary healthcare procedures. Sometimes it is related to setting claim reserves. Other times our customers want to determine the full scope of potential needs for immediate surgical procedures in the larger picture of immediate medical needs plus anticipated rehabilitation needs. In yet another situation our customers want a medical cost audit on hospital and other healthcare provider charges. Such situations require experienced medical expertise plus nurse case management. Through our alliance with Support Claims Services (SCS), CaseMed can provide Independent Medical Evaluations (IMEs) for Workers compensation, First Party Auto, Third Party Auto, and General Liability claims. In addition to SCS we have medical records preparation for professional expert reviews and Division Medical Evaluations (DIME) and IMEs through Front Range Medical Records and IME/Peer Review facilitation and scheduling through Expert Sourcing Solutions.
NATIONAL LANGUAGE INTERPRETATION SUPPORT
CaseMed has Hispanic speaking Nurse Case Managers and 200+ field and telephonic Language Interpreters to support 60+ languages for any Nurse Case Management and Medical-Legal Case Management situations.
WORKERS COMPENSATION & DISABILITY MANAGEMENT SUPPORT SERVICES
Particularly with severe employee injuries, CaseMed can develop Insurance Customer- specific Assessment, Early Intervention, Return-to-Work, Vocational Rehabilitation and Long-Term Disability Management programs.
ASK US ABOUT
- Substance abuse case management and support
- Patient advocacy services
- Home healthcare services
- Other needed services
MEDICAL CLAIMS DATA ANALYTICS
Working with Medical-Legal Solution's “Analytic-Powered Outcomes®” artificial intelligence (AI) and machine learning (ML) Workers Compensation technology processes, CaseMed provides “Best-in-Class” claims analytic solutions. Medical-Legal Solution's integrated relationship with CaseMed and the InsurHealth Affinity Group results in high quality analysis of the claim file sent to us through Medical-Legal Solution's technology analytics. The beauty of the relationship is that the technology sets up a refined and historical analysis of the claimant’s claim data for our case managers to apply the technology to the Patient Client’s injuries for rehabilitation. It is not a technology for technology’s sake. The case manager uses the results of the technology to develop high quality reports to our claims customers. The project reports through this case management method can help our customers with:
- Claims Reserve Setting
- Medical Forecasting
- Full Scope of Medicare Secondary Payer (MSP) Compliance including Professional Medicare Set Asides and Analytic-Powered (date driven) Medicare Set Asides
- Legacy Claims Solutions
- Fair and Reasonable Life Care Planning
- Customized Digital Journey Mapping and Support for Claims Customers
STRUCTURED SETTLEMENTS SUPPORT
CaseMed is passionate about applying all of its resources and services to the Holistic Coordination of Care for the Injured Worker. This is also true when becoming involved in Structured Settlement cases. Our case managers focus on helping to coordinate the Claims Settlement process by working with all parties involved in settling the claims that impact the Injured Worker’s healthcare and financial needs through his/her rehabilitation period.
The services we provide include but are not limited to:
- Case Management Suite of Solutions including Life Care Plans
- Medical-Legal Solutions Analytic-Powered Outcome Solutions
- Independent Medical Evaluations
- Medicare Set Asides
- Team Arcadia’s Structured Settlement Financial Solutions
GUIDESMART℠
Medical Case Management Software
GuideSmart℠ is a CaseMed Nurse Case Manager, end-to-end knowledge worker Software-as-a-Service (SaaS) workflow technology. CaseMed has deployed it for our Case Managers to process and record their activities including customer invoicing and project reports. GuideSmart℠ is available for all CaseMed employees and contractors managed under CaseMed and shortly it will be offered for other organizations working in a team environment with CaseMed, including InsurHealth members, and also claims reps assigned by their companies on files that CaseMed is working on. The benefit to claims reps is that they will have access to the status of their claim’s activities with CaseMed personnel to avoid delays related to followup emails and telephone calls. The claims rep can get 24X7 access to the files they are working on with CaseMed.
Integrated Claims Solution Suite
The following illustration of our National Alliance Partners is a specialized CaseMed and InsurHealth configured Suite of Claim Related Solutions to provide Best Outcome Values to the Claims Organization’s Sponsors.
