What are the results? Isn’t that what most people really want to know? At MedCost, we take pride in delivering positive Health Management outcomes to our clients year after year.

How Proactive Discharge Planning Positively Effects Patient Care and Contributes to Strong Inpatient Outcomes

If you ask one of your health plan members to describe what the MedCost Utilization Management (UM) program does, they may not have an answer. Yet, it is through the UM program that they find reassurance and answers to questions when facing a hospital admission.

Because being well-prepared for surgery is the first step to a faster recovery, the UM program from MedCost includes pre-operative education. Our experienced UM nurses answer members’ questions prior to surgery and proactively plan for a member’s discharge from the hospital.

The goal of the MedCost UM program is to provide members with the highest level of care and comfort before, during, and after their hospital stay. Discharge planning is just one way we help achieve that goal. Our hands-on approach and one-on-one interaction has decreased the number of hospital readmissions and post-surgery medical claims.

---

Real-Life Examples of How MedCost's Discharge Planning Has Helped Members

Assessing post-operative medication needs:
A member found out that he would be on an expensive blood thinner called Lovenox following surgery. In their pre-operative call, the UM nurse explained how the member may be able to get coverage and benefits for the drug since it is generally covered under major medical instead of a drug plan. She also referred the member to several web sites where he could get coupons or financial assistance to offset the co-payment amount, and encouraged him to discuss the situation with his physician for possible drug alternatives. Because of this proactive approach, the member discovered ways to make Lovenox more affordable and had arrangements for the medication in place before his surgery occurred.

Arranging for appropriate home health care and medical equipment:
A newly diagnosed diabetic spent 11 days in the hospital due to severe pneumonia and was discharged without home health services. During the follow-up call after discharge, the UM nurse discovered that the member had been sent home on insulin but was not provided with a glucometer to check blood sugar levels. The member also had little knowledge of a diabetic diet or how to give herself insulin, and there was no caregiver to help. The nurse provided diabetic education and encouraged the member to arrange for relatives to stay with her during the first few days of recovery. The nurse also contacted the member’s doctor and hospital case manager to update them on the member’s situation; they arranged for the member to receive a free glucometer.