Care Management ranges from coordinating care for members with complex medical conditions to assistance with hospital discharge planning.
Our philosophy is simple: We won't sacrifice quality nor deny our members benefit-eligible treatment. We also ensure that members receive care in the most appropriate setting.Accreditation: Premera is accredited by the National Committee for Quality Assurance (NCQA®). Achieving NCQA accreditation indicates that an organization is well managed and delivers high quality care and service. Accreditation enables Premera to communicate our vision of being the standard of excellence in our region, helping us to provide peace of mind to our members about their healthcare coverage.
NCQA is a registered trademark of the National Committee for Quality Assurance.
Hospitals routinely notify Premera of all inpatient admissions, which allows us to verify benefits, link members to other programs and assess the need for case management. Care Management programs are completely voluntary.
Pre-authorization for most services is not required, but some may be reviewed for medical necessity. These include experimental or investigational procedures. Others are listed in the member benefit booklet as contract limitations or exclusions.
Consumers are responsible for more of their healthcare decision-making than ever before. Healthcare decisions are the most difficult, challenging and stressful issues for families to deal with. The burden and stress placed on the consumer to manage their way through the complexities of today's complex healthcare system are significant.
Care Compass provides expertise in assisting members navigate through the healthcare system. Plus, through an assessment process, we recommend programs and services for members who may be at early risk for health concerns. We also assist members in coordinating support services needed to assist in their recovery and ongoing care.
Currently, the Care Compass program offers:
The Care Navigator is a Registered Nurse or healthcare trained professional. The Care Navigator is someone on “your side” to facilitate your healthcare needs and encourage health improvement. Our Care Navigators are available to support members in these ways to assist in coordinating acute, elective health-related events.
Case Management works cooperatively with our members and their physicians to identify and plan for the help they need to meet their healthcare condition. The goal? Better health outcomes and reduced readmissions.
Breast and Lung Cancer Program The Breast and Lung Cancer program is designed to help members learn about their diagnosis and treatment plan, and to help them get the most out of their health plan's benefits. Program services are provided by Premera.
An experienced nurse is assigned to each participant to help throughout their treatment. The nurse can:
To learn more about cancer or how to manage breast or lung cancer please see: