Utilization Management

How AIMM Helps Patients:

• Ensure that patient and family have emotional support
• Ensure that patient and family have information about diagnosis, prognosis, treatment options, complications, interactions, contraindications, etc…
• Ensure that patient and family have resources
• Empower patient and family to be better consumers of their health care resources
• Ensure that diagnostic evaluation is being done appropriately (and that it is the right kind of test for the patient’s individual situation)
• Ensure that patient receives timely information about results of diagnostic evaluation
• Ensure that the efficacy of treatment is being evaluated routinely and appropriately
• Ensure that the treatment patient is getting is either working or being changed timely to something else
• Ensure that the treatment patient is getting is the most likely thing to work for them (or that the most likely thing to work should not be used for them due to some clinical reason)
• Help patient to overcome any barriers that may be preventing them from getting the highest quality health care possible (access to providers with the correct expertise, mobility/transportation issues, financial resources, etc…)
• Help patient to get care in the most cost-effective means possible thereby prolonging their coverage under their limited lifetime maximum
• Help patient navigate the insurance system and be a resource for getting information about PPO status of providers, coverage issues, plan exceptions and exclusions, etc… so that they know the financial impact they will personally encounter
• Advise patient and family about end-of-life options, resources, support

Transplant Coordination
This is often a component of Case Management that can control large-dollar claims associated with solid organ and bone marrow transplants. Ault International Medical Management has access to many transplant networks (aka Centers of Excellence). Ault International Medical Management will work with the reinsurance carrier to utilize resources that can significantly lower transplant-related claims costs. If a Centers of Excellence facility is not available, the transplant case manager will attempt to negotiate with the transplant facility.

Disease Management
Patient-centric medical management of patients with chronic diseases. Disease Management addresses chronic illnesses such as Asthma, Diabetes, Hypertension, Congestive Heart Failure, COPD, Coronary Artery Disease, and other chronic health conditions. Disease Management patients are identified through the FREE Mini-Health Risk Assessment Survey, through the Comprehensive Risk Assessment Survey, through precertification, and/or through claims data mining software.

Wellness Management
This is a proactive approach to patient-specific wellness management with an emphasis on education and compliance. Wellness Management addresses compliance with issues such as Mammography, PAP Smears, Prostate Screening, Childhood Immunizations, and others.

The term "Disease Management" under the A.I.M.M. model is a misnomer. We believe, and our experience has supported, that the most effective, most well received, programs are "Patient-Centric" as opposed to "Disease Centric". Therefore, our program focuses on identification of patients who could benefit from the individualized attention and assistance of a professional Registered Nurse in controlling their health condition(s). Any patient with any health condition who is not currently utilizing "best practices medicine" would be a candidate for our program. As you would expect, this will include patients with diagnoses such as asthma, diabetes, hypertension, coronary artery disease, and chronic obstructive pulmonary disease, but is not limited to those diseases! Other diagnoses that might require the interventions of a nurse include (but are not limited to) chronic fatigue, fibromyalgia, lupus, multiple sclerosis, chronic pain, back problems, etc... Other patients may need assistance, but not yet have a clearly defined diagnosis, such as excessive Emergency Room utilization, or what we affectionately term "ER hopping and Doctor shopping".