Medical Management

Medical Management Programs

Medical Management Programs: programs to assist physicians with care management of their patients and to provide tools for effective resource management and clinical integration of our provider network.

These programs include: Community Nurse Case Management, Telephonic high risk care management, Clinical Pharmacy management and consultation, Referral Management, using the NEHEN Express application to process and review specialty referral and other outpatient services, and to work directly with hospital departments and physician practices to foster in-network care; and Utilization Management, through daily interaction with managed care Plan case managers and BIDMC case managers to review and facilitate inpatient care processes.

Our medical management programs provide the tools and support to physicians, enabling them to improve the quality, safety and efficiency of care for their patients. Programs address key elements of quality, cost and utilization that will produce the best outcome for patient care and contract performance:

  1. Managing inpatient utilization and days/thousand members
  2. Generic prescribing and electronic prescribing promotion via one on one support
  3. Accessing the BIDPO and BIDMC provider network when clinically appropriate
  4. Providing high risk case management and promoting healthcare improvement programs for patients of our participating providers
  5. We will assist you in the use of the SafeMed radiology application for Blue Cross patients.
  6. Promotion of Electronic Health Records via a joint program of BIDPO/BIDMC and eClinical Works.