Health Services encompasses all aspects of disease management /health supportt, population health management, utilization review and case management. We rely on our own Medical Directors, our highly qualified staff and a robust data management and reporting system to ensure that we balance the best mix and intensity of clinical service with cost containment.
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Disease Management / Health Support
We team Valley Preferred physicians with our own RN Health Specialists to help improve patient care and to reduce the costs of chronic diseases. Our Disease Management services include patient-specific assessment, coaching and education, coordination of care, open communication with the primary physician, and physician self-audits.
We are continually developing new chronic disease management programs to help achieve quantifiable improvement in health quality on a year-to-year basis. Disease management programs are available to eligible Valley Preferred members* with the following conditions:
- Asthma / Pediatric Asthma
- Congestive Heart Failure
- Coronary Artery Disease / Vascular
- Diabetes
- Healthy Lifestyles (Obesity)
- Hyperlipidemia (High Cholesterol)
- Hypertension (High Blood Pressure)
*Members eligible for disease management are members whose health insurance is either Lehigh Select, Valley Series or Lehigh Valley Health Network Health Plan (Choice Plus).
Please check with Valley Preferred at 610-969-0417 or 1-866-293-5452 to determine if your Valley Preferred member qualifies for one of our disease management programs.
Members: For more detailed information about Valley Preferred's Health Support Program, please view our Patient Guide.
Physicians: For more detailed information about the Valley Preferred's Health Support Program, please view our Physician Guide.
Population Health Management
We do more than just monitor the health of employee populations; we assess group health care profiles to determine the steps necessary to enhance health, while also encouraging individuals to become their own health advocates.
Moreover, we produce results. Our integrated health programs help patients make a variety of better lifestyle choices, which lead to fewer work absences, reduced medical costs, better health, and better job performance.
Utilization Review
Health Services uses medical guidelines to determine the appropriateness of medical services, specifically monitoring inpatient levels of care, drug utilization, rehabilitation therapies, and the use of durable medical equipment and other services to provide high quality care in a cost-effective manner.
Utilization Review services ensure cost-effective care that is medically necessary and delivered in the most appropriate setting, based on nationally recognized and widely accepted guidelines and criteria, including Milliman Care Guidelines® and pathways and protocols approved by Valley Preferred’s Care Management Committee.
Case Management
Case Management is designed to reduce risk and unnecessary costs related to an individual’s health care needs. Our RN Health Specialists develop health care strategies that meet the specific needs of patients suffering from a catastrophic illness or injury while coordinating and monitoring all aspects of their care to maximize the treatment received and the cost-effectiveness of that care.
Case Management coordinates resources and identifies appropriate, cost-effective alternatives on a case-by-case basis to help achieve realistic treatment goals.