Cutting Costs of Allied Care

Fraud and inappropriate care are major contributors to rising healthcare premiums. To fight fraud and improve allied specialty care for patients with chronic health issues, Triad Healthcare (Cleveland) and CGI-AMS, a part of technology and business process services provider CGI (Montreal), have partnered to offer healthcare payers a full range of care management services, including chiropractic, physical therapy, acupuncture, massage, naturopathy and physiatry related to pain treatment.

"This partnership says the real way to control the medical cost of delivering allied services is through good clinical outcome," says Rob Rolf, director of consulting services for CGI-AMS. "We are working with pre-approved care management plans, along with a system to review these plans for each benefit recipient, to lower recurrences or change treatments that aren't resulting in improvement."

By combining a proprietary Web-based system provided by allied specialty healthcare solutions manager Triad with business process services from CGI-AMS - including care management, clinical audit and fraud detection systems - the joint care management plan is designed to efficiently process valid claims, flag questionable claims and suggest the best course of treatment. "The technology connects providers to a network of medical professionals, providing the ability to track the performance of certain therapies across the medical professionals' entire client base," relates Rolf. Previously, allied services were viewed as patient benefits rather than critical components of treatment, he adds. They were not "outcome-based or medically based," Rolf says.