Utilization Management
Through our utilization management program, America's Choice helps eliminate unnecessary medical procedures and hospital stays. This not only saves you money over the long-term, it assures that your employees receive the appropriate care. Several components make up our utilization management program:

Clinical guidelines
The nurses who approve care during the pre-certification process use the most current clinical guidelines, avoiding unnecessary hospital admissions, improving referral management and protecting your employees from unnecessary invasive medicine. As a result, hospital days are reduced, on average, to 161 per year per 1000 members vs. 761 nationally, and hospital admissions are reduced, on average, to 40 per year per 1000 members vs. 118 nationally.

Large case & disease management
Several programs, such as MaterniCareª, are in place to help reduce the substantial costs involved with large case and disease management. In each of these programs, nurse case managers coordinate patient care for serious, complex cases to reduce case costs and ensure the delivery of appropriate care. Typically, employers average a 9:1 return on investment from these programs, with a 45:1 return for high-risk pregnancy programs.

Demand management
Through our 24/7 nurse hotline, members can get their health questions and concerns addressed and receive guidance on the type of care they should seek. Often, this involves redirecting members from inappropriate ER and physician visits to appropriate, lower-cost alternatives. This type of demand management typically reduces the number of physician visits by roughly 12% a year per 1000 members, with a 14% reduction in costs, and reduces the number of ER visits by roughly 9% a year per 1000 members, with a 21% reduction in costs. In addition to your cost savings, your employees will appreciate the immediate access to our knowledgeable nursing staff, who can help ease their worries and tell them what they need to do.