| CareGuide
is leading the health, disease and care management industry into the
future with the Care Team ConnectTM (CTC) System of Care – a
fluid, holistic member-centric approach. Our best in class technology
platform allows for a truly integrated methodology powered by sophisticated
data analytics that pinpoint areas of need and deploy meaningful,
evidence-based interventions as they are needed, all the while engaging
the entire care team. |
| CareGuide’s
sophisticated, data-driven analytics will evaluate your entire population
and translate your data into meaningful, actionable information. This
allows us to identify areas of need from the broader population level
and drill it down to each individual member. Then we evaluate where
CareGuide can best serve your members while lowering your overall
healthcare spending. |
Although
we take a broad population approach at the outset, our integrated
model is centered holistically on the individual with the goal of
removing barriers to achieve an optimal level of self-management.
Rather than providing specific service categories into which members
must fit, CareGuide’s Care Team ConnectTM (CTC) system of care
revolves around the individual’s needs and adapts to his/her
health status—providing support, access and education all along
the continuum.
With this approach there is no risk of missing members in need who
fall outside of defined parameters and we are more likely to engage
members at a teachable moment when they are most open to health supporting
intervention. Our ability to assist a member at any stage of health
status sets us apart and achieves optimal value for the members and
clients we serve. |
CTC’s
core components are used to analyze and assess need in order to bring
members into more intensive interventions whenever they need assistance.
These core components are:
 |
Data Analytics:
Sophisticated predictive modeling and retrospective claims review. |
|
Health Risk Assessment:
Gathers self reported data to help identify appropriate health
interventions for members at risk. |
|
Health Coaching:
Helps members understand health risk/conditions and connect
to appropriate health resources. |
|
24/7 Health Call
Center: Registered Nurses assist members in making appropriate
healthcare decisions. |
|
Utilization Management:
Optimizes benefits through inpatient/outpatient precertification,
continued stay review and behavioral health utilization review. |
|
Provider outreach:
Communicates patient status and care planning through telephonic
and mailed correspondence. |
|
As health
status moves to a more intensive/acute level, members are shifted
seamlessly between the CTC intervention modalities until the barriers
to self-management have been removed or mitigated. These intervention
modalities are:
|
Disease Management:
Member has chronic illness and requires education, coaching
and assistance with behavior modification. |
|
Care Management:
Member has experienced a change in health status requiring active
clinical intervention. |
|
Complex Care
Management: Member has experienced an acute/life threatening
change in health status and requires daily monitoring and perhaps
onsite management. Generally, family or caregivers are involved.
Palliative and end of life care are included in this level. |
|
Specialty Modules:
Members can access maternity management, geriatric caregiver
assistance programs and other specialty services through this
module. |
|
The CTC system of care is housed on an Integrated Platform that not
only supports all the components and intervention modalities, but
it also facilitates continuous streamlined communication to all caregivers
and stakeholders. This allows for a comprehensive, up-to-date care
plan centered on the member’s current needs.
Ultimately, the goal of CTC is to be able to intervene early and meaningfully
and to transition the member to a less intensive level of intervention
as soon as possible. This approach allows us to effectively mitigate
health risks while reducing overall healthcare spending. |
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