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December 1, 2007
NGS Care Management
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We're pleased to share with our clients that, effective February 1, 2008, NGS' care management program, including utilization review, case management, and disease management, as well as our new doctor driven wellness programs (that will be introduced to you shortly), will be provided internally rather than outsourced. We believe this change will enhance our abilities to minimize your claim costs by maximizing the health potential of every plan member!
While we're excited about our new integrated programs, we recognize that our clients may have many questions about the change, as well as the transition process. We've prepared the Frequently Asked Questions below to help address this need and you'll be hearing more as we move forward.
Will the Hospital Verification Program continue to be provided on site at NGS?
Yes, absolutely. The same staff will continue to serve our clients for this program. The system used to "build cases" will be changed from our current vendor to Medecisions. Medecisions is a software and services expert in care management.
Will the Hospital Verification Program continue to be URAC accredited?
Yes. Previously, the management of URAC accreditation, maintenance of URAC policies, field supervision and URAC's required Total Quality Management programs were outsourced. These functions will now be managed by our sister Coresource office in Lancaster, PA.
What about case management services? Will they still be integrated with the Hospital Verification Program?
Yes. The Medecisions system supports the same automatic triggering of potential case management candidates. In addition, data analytics software is utilized to mine claims data for additional candidates who may be receiving acute care on an outpatient basis.
Who will perform case and disease management services?
Case and disease management services will be provided by more than 72 registered nurses and certified case managers that are all on staff, located in our Lancaster, PA office. Each staff member averages more than 12 years of clinical experience in a wide variety of clinical specialties.
What about the maternity management program - is it also changing? Will there still be a demand management nurseline available?
Yes. Maternity management and demand management will be provided by Matria Healthcare. Matria is a leading provider of comprehensive health enhancement programs for employers and health plans. Matria has earned NCQA's Full Patient and Practitioner Accreditations for its obstetrical programs. In fact, through NCQA's rigorous evaluation and measurement process, Matria scored 100 percent on all six of the organization's accreditation categories.
What about individuals who are in case or disease management on the effective date of the change?
Rather than disturb relationships that have already been formed with case management nurses, individuals currently in case management will continue with their current case manager through the end of 2008. For disease management, we will work individually with each client to ensure a smooth transition.
Will there be a change in the fees we pay for care management services?
There will be no change in fees charged to our clients as a result of this transition.
How will the client benefit from the change?
Our programs have received favorable rate discounts from many stop loss carriers and also offer negotiated arrangements for certain types of acute care. More importantly, we believe that our programs offer a superior level of integration as well as a greater ability for us to respond to customer needs and drive new models of care management in the future.
If you have any questions about these upcoming changes, please do not hesitate to contact your NGS Sales or Account Manager.
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The Patient Protection and Affordable Care Act of 2010 
