Medical Management



Our medical management approach begins by building a partnership with our clientele, thoroughly analyzing and understanding the unique challenges they face. We then apply cutting-edge cost containment methods, reducing costs while maintaining a quality employee benefits program. We provide comprehensive medical management services through a professional staff of physicians and nurses who are highly qualified in cost management issues including quality assurance standards.

Utilization Review


IHP’s utilization review program combines the expertise of registered nurse reviewers to ensure you are optimizing your benefits plan. IHP ll Powered by AmWINS works with board-certified medical directors and practicing physicians to help direct patients and providers toward the most cost-effective, quality-driven treatment available. Our utilization review services use established national medical guidelines to evaluate the medical necessity for hospitalizations, outpatient services and appropriateness of overall treatment plans.

Utilization Management

Our utilization management team identifies high-risk/high-dollar conditions and communicates them to the team so the appropriate actions can be taken to minimize the risk and maximize the benefit to the plan and plan member.
Utilization management supports:


Pre-authorization

Inpatient Concurrent Review

Discharge Coordination


Innovative Health Plan ll Powered by AmWINSalso provides a variety of administrative services including: Clinical expertise, appeals, external review organization facilitation, pharmacy coordination, post-claim medical review and review for stop-loss.

Disease Management


Disease management teaches patients how to manage a chronic disease. IHP ll engages members in their own health management through biometric screenings that help identify members who are at high risk for chronic or serious illnesses. Members learn how to take care of their specific health concerns and learn to avoid potential or worsening problems with their health.

Case Management


Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy. IHP ll Powered by AmWINS offers options and services to meet individual and family health needs through communication and available resources that promote quality, cost-effective outcomes.

Case Management involves in-house RNs, board-certified medical directors and physicians who are there to:


Protect against over, under and inappropriate utilization of services

Negotiate with out-of-network hospitals and contracts

Complete pre-authorization and continuous review

Monitor services to ensure effectiveness and cost-saving results of treatment

Specialty Case Management

We offer custom features so employers and employees can easily navigate and maximize services while containing costs.

Organ Transplant Program
Full coverage for catastrophic costs associated with organ transplants