Summit ReSources Portfolio of Services: Disease Management

Cost savings from proactive disease management coupled with patient self management through education: Health Management Corp., Inc.

This award-winning health and disease management company addresses high-cost, high-impact conditions to achieve definitive value for health plans, employers and government entities.  Disease management is available for asthma, congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, diabetes, low back pain and metabolic disorders (e.g. obesity).

Quality Oncology

Quality Oncology, a subsidiary of Matria Healthcare, Inc., is the largest and most experienced provider of comprehensive cancer treatment support programs. Quality Oncology’s approach utilizes the expertise of seasoned oncology nurses and physicians, assisted by a state-of-the-art, web-based Integrated Care Management system with embedded evidence-based cancer treatment guidelines.

Matria Healthcare, Inc.

Total Health Enhancement Solution includes a combination of preventive, educational and care management services and programs designed to curb costs while improving employee health. Programs include maternity (including gestational diabetes and high-risk pregnancy), neonatal intensive care, asthma, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure,   diabetes, depression, acute low back pain, and obesity management.

United Resource  Networks

URN’s Cancer Resource Services program targets the relatively small number of complex cancer patients that drive the majority of the medical expense related to the treatment of cancer.

EnvisionCare Alliance, Inc.

EnvisionCare’s Kidney Management Services (KMS) program provides clinical consulting and administrative services that can reduce complications and costs associated with end stage renal disease.

URN Claim Enhancement

If you use United Resources Network (URN) through Summit Re to manage your transplant cases, the access fee can be submitted and considered as a claims expense if the claim exceeds the annual retention. Also, URN network claims will be considered at a higher coinsurance level and the average daily maximum limitation (ADM) will not be applied to case rates (Base Payment Rate or BPR). Should a URN arrangement go into an outlier arrangement, the BPR, or case rate portion, is still not subject to the ADM. Only the outlier portion will be subject to the ADM. This provides for higher reinsurance recoveries to the plan, and it is handled via claim administration guidelines rather than by policy amendment.

Reports Help You Manage Costs

Important trends in your claim experience as well as potential utilization of appropriate managed care programs through Summit Re are available through our extensive management information reporting package. In addition to routine reinsurance claim explanations of benefits (EOB’s), Summit Re offers a variety of claim reports regarding turnaround time, diagnosis and managed care vendor utilization savings.