Medical management, cost and quality programs

Programs

Care management

Care management delivers a personalized model that focuses on each member holistically. This model provides members with the greatest unmet health care needs with a single case manager to support their medical and behavioral health. Our case managers are an extension of the member's provider team and support each member in meeting their health care goals.

Quality Program

When you share cost and quality data with our members—your patients—they can make more informed health care decisions. Read about our quality program.

Medical management

Our medical management programs are either targeted to specific conditions or designed to improve or maintain overall health. Programs include case management, diabetes and disease management, palliative care, radiology, cardiology and physical and sleep medicine.

Member programs and tools

Member programs highlight the enhancements to the total benefit package provided to our members, such as health coaches, a 24-hour nurse advice line, and discounts on health products and services. These programs help our members live healthier lives.

Peer-to-peer review

A peer-to-peer review is a telephone conversation between a licensed BridgeSpan physician and the physician or other health care professional requesting authorization for coverage. A P2P is not an appeal and is not intended to overturn the denial. The purpose is to further understand the reason for the denial based on our medical policies.

Risk Adjustment program

Risk adjustment is designed to encourage insurers to compete on quality and efficiency, preserve consumer choice and improve quality of care for patients.

Quality Incentive Program

Earn incentives when you address and close care gaps for on-exchange members.