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Medical Management
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Gordian is
an independent, licensed UR agent and leads the way in
providing comprehensive care management services for
risk-contracts including:
- Precertification
- Utilization
Review for hospital and ancillary services
- Referral
Coordination
- Episodic
Case Management
- Reporting
and Data Analysis
We
currently manage health services for more than 40,000 Commercial
and Senior members for a large health plan in the North Texas
area. We work with large hospitals and over 500 primary
care physicians and specialists in a risk environment.
Our success with this program is attributable not only to
our expertise, but also to our ability to work collaboratively
with all health care providers in a mutually beneficial manner.
Download
Brochure
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Case
Study |
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The
Challenge:
John
is a 52 year old businessman who came into the ER complaining
of severe chest pain. After
a complete work-up to rule out MI, he was transferred to CVICU.
Due to his test results, he underwent a CABG and spent
the next four days in the hospital.
Because of ongoing complications, John was transferred to
a skilled nursing facility until his dismissal two weeks later.
At home, he needed medical equipment and home health care
to recover safely.
The
Solution:
John’s
Gordian case manager was notified the day of his admission.
She was in contact with his doctors and arranged for
approval of all hospital services and eventual transfer to the
skilled nursing facility.
On discharge, she arranged for home health and delivery
of his medical equipment.
The
Benefits:
Since
Gordian worked closely with all members of the health care team,
John’s care was seamless, his family was satisfied with his
care, the providers were reimbursed appropriately, and the
health plan reported cost savings since all services were
provided at in-plan rates.
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