“Clinical Case Management” – made possible by the presence of Medical Staff – for each individual claim but with a focus on admissions, consists of:
- Checking the consistency between the therapeutic process and the initial diagnosis (“appropriateness” of health services);
- Mitigating the phenomenon of “hyper consumption” induced by provisions (over-delivery);
- Establishing direct contact with Health Care Workers to assist patients throughout their treatment process;
- Promptly resolving issues related to covering diseases and surgical and medical methods/end goals;
- Updating the previous assignment of responsibility in the event of complications that change the original authorisation parameters, paying maximum attention to the consistency of performance, especially for hospitalisations without surgery and at Day Hospitals;
- Verify whether costs incurred are reasonable, in relation to either specific pathologies of individual persons or rates and agreements made with the medical provider and medical professionals.
The end goal is to obtain the correct costs with the correct amount and quality of care for each individual case.
