Physician WebLink’s care management program uses a process of assessing, advocating, coordinating and evaluating patient needs, options and services in order to improve the quality of outcomes for both the patient and their family.
Our care management program is comprised of individualized services that are consistently administered, cost effective, and provide partnership opportunities with providers and patients.
Physician WebLink’s care management staff consists of registered nurses and clinical intake coordinators. Our reviews are based on nationally accepted clinical criteria, and our programs result in more appropriate utilization of health care resources than found in the general population.
As managed care has evolved, so have Physician WebLink’s clinical offerings. That’s why we offer innovative programs such as Prospective Health where entire populations are analyzed, and then stratified to identify those individuals who could benefit the most from early (prospective) intervention for specific evolving disease states.
On behalf of the client, PWL’s pre-certification program reviews a select list of medical services for medical necessity. In addition a review of benefits and compliance with any network contractual constraints is performed. PWL can provide a standard listing of services recommended for pre-certification, or can work within employer benefit guidelines to administer specific pre-certification programs.
Physician WebLink employs a combination of automated clinical systems, registered nurses, administrative and physician staff to administer pre-certification guidelines. Service highlights include:
Utilization of national and local medical standards as appropriate
Automated, rule based clinical guidelines with real-time responses via Practice Connect®
Pre-admission assessments and phone calls to high risk surgical patients
PWL performs a combination of on-site and telephonic review of hospitalized patients. PWL nursing staff actively track and manage inpatient stays, and coordinate care with the patient’s physicians.
Our Concurrent Management program is designed to ensure that all inpatient stays are medically indicated and that care is provided in the most appropriate setting. Service highlights include:
Case management and early discharge planning to facilitate the transition to outpatient care.
Identification of patients for enrollment in focused Case Management programs.
Management of patients, and patient information using Practice Connect®, a secure internet portal
This program is designed to manage and coordinate care for patients requiring a short-term course of extensive multi-modality care. Case Management referral criteria are used as indicators of patients who will likely require on-going services from multiple providers, and who will benefit from individualized care coordination.
Through early identification and intervention of these patients, our Case Management program is able to better manage the services that typically incur the highest costs. Service highlights include:
Dedicated PWL personnel trained in care management processes and procedures
Evaluation of patient/family understanding of disease, treatment and goals, and the expected outcome
Routine telephonic interaction with patients for monitoring of condition and health status, assistance with appointment facilitation, and community and ancillary service referrals
Physician WebLink’s Population Care Management program uses human interaction and electronic-based technology to manage and coordinate treatment courses for patients who fall into specific chronic diseases and high-risk categories.
The goals of the program are to achieve consistent, system-wide excellence in the care of chronic diseases, and to increase medical cost savings by managing patient care within accepted and proven guidelines.
Physician WebLink utilizes data to identify patterns of patient care at a population level, and then aggregates cohorts of patients requiring unique tracking and intervention. Intervention is achieved through the use of a proprietary internet patient tracking system (Practice Connect®) that facilitates the interface of administration, nursing staff, patients and their physicians. Service highlights include:
Development of referral criteria for identification of members specific to client’s patient population
Comprehensive initial assessment, including history, and current symptoms, and development and management of individualized care plans
Active management of patient care and tracking of key indicators identified for the successful management of a condition
The purpose of Physician WebLink’s Quality Management (QM) program is to maintain a comprehensive, coordinated process that continually elevates, monitors and improves the quality of clinical care and service provided to enrollees within a health care delivery system.
PWL strives to identify, prioritize and implement improvement opportunities, and encourages on-going participation from all areas of the healthcare delivery system (i.e., participating physicians, hospitals, ancillary providers, health plans, etc.). Service highlights include:
Development of annual and on-going QM plans
Administration of member and provider grievance processes
Compliance with applicable state, federal, health plan and other accrediting agency requirements
Physician WebLink can help select and arrange for employment of a Medical Director on behalf of a provider network. The Medical Director will then direct the medical management and procedure development for all clinical service activities. Service highlights include:
Provide secure access into PWL systems specific to the Medical Directors’ roles and responsibilities
Provide all administrative and office support for the Medical Director to conduct client business
Provide access to training and education specific to the needs of the client
