Clinical

    PLEASE INSTALL THE BREADCRUMB NAV XT PLUGIN!

 

StrataCare is thrilled to offer various clinical solutions through its affiliate: Bunch CareSolutions.

As a pioneer in the industry, Bunch CareSolutions has been delivering high quality medical cost containment solutions for 25 years. Below are links to details of some of the award-winning service delivery available to StrataCare’s clients:

Strata-Nurse-practitioner

 

Clinical Claim Intake

Clinical Claim Intake (CCI) goes beyond the normal intake process to integrate claim intake with panel direction and nurse intervention to increase network savings, penetration and control. CCI also provides efficient and convenient claims reporting. Integration with a triage nurse at the point of injury offers immediate assistance with provider channeling and medical direction at the first report of injury (FROI). When used in conjunction with Nurse First Response™ (NFR), system integration makes it possible to “hot transfer” employees to a nurse for assistance with medical treatment options.

 

Nurse First Response (NFR)

This stand-alone solution provides nursing expertise at the point of injury, using symptom-driven clinical decision protocols to direct the patient to the right level of care with the right provider at the right time. Bunch CareSolutions combines various clinical resources and extensive nursing experience to develop protocols that encompass the clinical decision matrix for NFR. With NFR, employees benefit from cost containment/elimination, emergency room avoidance, channeling to preferred providers, and employee advocacy and goodwill.

 

Telephonic Case Management

Bunch CareSolutions is the nation’s premiere telephonic case management (TCM) firm with licensed coverage in all 50 states. Bunch CareSolutions TCM services are aligned geographically to provide the client and the injured employee with registered nurses who are jurisdictional experts and familiar with the providers in the local community. All of Bunch CareSolutions’ nurse case managers hold the appropriate state licensure, including those states with specific case management or credentialing requirements. With more than 200 nurses dispersed geographically across the country, rest assured the best possible medical cost containment program will be customized to your needs.

 

Field Case Management

To optimize the quality of case management, while containing the managed care costs, Bunch CareSolutions has established a national field case management model.  Recognizing the value of personal visits with critically injured workers and treating providers, field case management is also available to enhance return to work and/or maximum medical improvement outcomes.  A team of staff case managers and vocational rehabilitation specialists are geographically dispersed throughout the country.  In addition to staff employees, a national network of highly-experienced workers’ compensation case managers are contracted through an affiliate network.  This broad network ensures our referral sources will have access to a case manager that can support their needs on catastrophic claims.

 

Utilization Review Program Services Bunch CareSolutions’ URAC-accredited utilization review (UR) program facilitates the timely and appropriate treatment of injured employees while providing greater financial controls. We offer both integrated and standalone UR services to help clients more effectively manage their workers’ compensation costs and all UR programs are customized according to state and client specifications.

UR services are provided by highly-skilled, licensed clinicians using state-mandated and/or numerous nationally-recognized treatment guidelines. Our UR program provides the following URAC and state-certified services:

  • Prospective review
  • Concurrent review
  • Retrospective review
  • Pharmacy/drug utilization review
  • Peer review/physician advisor
  • UR strategy (for states without jurisdictional guidelines in support of UR)

Physician Advise & Peer Review In a medically-driven approach to case management, UR is the first line of review for medical necessity. If the requested service does not meet the guidelines for UR, it is then sent to a physician advisor for a physician review of medical necessity for a proposed medical treatment. Physician peer review is a review of medical documentation and is performed to help clarify or help resolve or determine disability management issues, such as compensability, return to work, maximum medical improvement issues and impairment ratings.

During this review, the physician determines the medical necessity of a proposed treatment by reviewing the guidelines, medical documentation and making peer-to-peer contact with the prescribing provider. Physician peer review provides another level of review and is performed to help clarify or help resolve or determine disability management issues, such as compensability, return to work, maximum medical improvement issues and impairment ratings.

 

Medication Management

Oversight Services

PHARMADx™ is a suite of clinical services designed to provide additional levels of pharmacy management and oversight that extends beyond the typical PBM partnership. PHARMADx™ optimizes medication utilization and cost containment on workers’ compensation claims.

PHARMADx™ is comprised of the following clinical components:

  • Ongoing formulary review and management
  • Comprehensive utilization review of drugs (CUReD)
  • Pharmacy resolution nurses
  • Synchronized patient management
  • Formal drug approval process
  • Chronic medication protocol development
  • Precursor to Medicare Set Asides (MSAs)
  • Retrospective pharmacy analysis
  • Program validation and education
  • Reporting and data analytics

With PHARMADx™, employers are able to maximize pharmacy management, decrease prescription costs and increase program savings by identifying the over-utilization of prescription medications.

 

Biopsychosocial Assessment Bunch CareSolutions has implemented a patent-pending Comprehensive Initial Assessment™ (CIA) tool. Highly-skilled registered nurses are able to define clinical pathways at the point of injury, giving claims adjusters and nurse case managers the ability to effectively manage recovery and return to work outcomes for injured employees.

CIA fully integrates nursing expertise, evidence-based treatment guidelines and sophisticated biopsychosocial assessments to map the anticipated progression of a claim. CIA identifies specific physical, social and psychological risk factors and their potential impact on an injured employee’s recovery. CIA gives adjusters the power to:

  • Efficiently manage resources
  • Reduce lag time by determining proper claim direction
  • Avoid escalation of claims from medical only to lost time
  • Pinpoint biopsychosocial risk factors impacting expected recovery and return to work
  • Rethink treatment path when improvement is minimal