Pioneering Neurological Care Management

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Who We Serve

We’re dedicated to serving the patients with the following conditions as well as other related neurological conditions:

How We Help

Utilize Health offers a specialty care management solution that helps Health Plans improve the care of members with severe neurological conditions while reducing costs. These members are often hidden within the claims data, and can account for 12-24% of annual spend (depending on line of business). Our solution identifies these members, improves their outcomes, reduces costs and increases satisfaction. All of this is accomplished while maximizing the member’s potential for recovery.

The Hidden Costs of Patients with Neurological Conditions

Members with severe neurological conditions are very difficult to locate in claims data so their true costs are rarely understood. Sometimes these members are misclassified because they are classified according to the original diagnosis category.

Members can also fall out of the data because they don’t have easily identified diagnosis codes. Utilize Health has built a unique data algorithm that quickly identifies these members. Health plans are often surprised to find that this neuro member group represents up to 4.5% of their population and anywhere from 12-24% of total healthcare costs. This patient category is ripe for intervention.

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U.S. Claims Costs for Neurological Conditions:

$100 BILLION ANNUALLY

Take a Solution Focused Approach

Providing members and their caregivers with education, guidance, and specialized condition support results in better decision making that ultimately improves care and reduces ongoing care costs. We take a comprehensive approach to maximize the impact to the member and health plan. Our process includes:

Member Identification

Member Identification

Utilize Health’s proprietary analytics model will quickly identify your severe neurological members and their corresponding risk levels. This allows us to manage different risk profiles with services commensurate to their needs.

Neuro-Focused Care Management Approach

Neuro-Focused Care Management Approach

Severe neurological members must be managed through a neuro-focused lens. Utilize Health manages member care through Patient Advocates, which are specialty trained clinicians that are well-versed in neurorehab and have worked in a multitude of neurological care settings. Patient Advocates focus on the whole patient through three key areas: Health, Social, and Environmental.

Community Health Workers

Community Health Workers

These members of the care team are the “eyes and ears” of our program and work in the member’s home to address areas such as member/caregiver education, social determinants of health, early warning signs of secondary conditions, mitigation of barriers to care, etc.

Care Path Optimization

Care Path Optimization

Post-acute care guidelines are lacking for patients with severe neurological conditions. They do not follow typical recovery patterns, e.g. patients that have some level of paralysis. Using established evidence-based guidelines and its own program outcomes, Utilize Health is building new post-acute care trajectories for its members that will be industry changers.

Facility Optimizer

Facility Optimizer

Utilize Health has collected nearly 14 years of data on rehab facilities and specific therapies across the country. Using many data variables, this tool matches the member/diagnosis to the optimal in-network facility to generate the best possible health outcomes for that member. This is the only database of its kind in existence.

Intuitive Technology

Intuitive Technology

Our work in understanding members with neurological conditions is unparalleled in the industry. Our deep understanding shows in how we’ve developed our digital tools for the members and their caregivers with such elements as secure messaging, therapy and equipment libraries, and much more.

Our Three Key Value Drivers

Our programmatic approach of providing specialized care management solutions delivers value in three key areas:

1. Improving Health Outcomes: By ensuring a neuro-focused care management approach along with an optimized care path and facility match.

2. Reducing Care Costs: By focusing on the appropriate levers that impact care costs the most, such as optimizing utilization, patient/caregiver education, hospital readmissions, secondary conditions and exacerbations

3. Increasing Patient Satisfaction: Through building a trusted relationship that extends to your brand.

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