CarePlus
Comprehensive Care and Care Management for Medically Complex, Chronically ill Members – Delivered Where They Live.
The current healthcare delivery system often underserves the many complex needs of
difficult-to-manage members. This can lead to significant cost and quality-of-care
issues. These members, generally around 5% of a health plan’s membership,
typically drive as much as 50% of the plan’s total medical expenditures.
INSPIRIS CarePlusSM focuses on improving care for a plan’s most chronically ill
and costliest members. The program targets members who have a history of over
utilization of high-cost services, such as ER visits and acute admissions. These
members often have multiple chronic conditions with associated functional or
cognitive issues, psychosocial complications and an array of co-morbidities that
render them high-risk. Challenges related to multiple providers and medications
produce disjointed, confusing, and sometimes contraindicated care plans.
The resulting gaps in care and lack of adherence lead to excessive medical crises
that are expensive, undesirable from the member’s standpoint and avoidable.
The Solution for Your Most Costly Members
• Highly predictive member selection/identification process
• Provider-led comprehensive in-home assessment (physical, psychosocial, environmental,
medication review, caregiver support), diagnosis and treatment
• Capture and documentation of all co-morbid conditions and disease status to accurately reflect
the health status of the member
• Fully integrated, comprehensive care plan development that spans medical, social and behavioral
needs (coordinated with PCP and other specialist)
• Ongoing coordinated care and collaborative relationship with primary care, specialist and
ancillary providers
• Regular INSPIRIS provider visits to member’s home (both maintenance and urgent response)
• Frequent tailored care management interactions - each member is assigned an RN Care Manager
and a Care Management Assistant
• Urgent response care in place – providers are on call 24/7/365 to address urgent member
• End of life/advanced illness orientation, education and planning
• Electronic Medical Record – health plan portal to access care plan, interventions and notes,
auto fax of all care plan changes and visit notes to PCP
INSPIRIS’ high-touch, comprehensive CarePlus program addresses the needs of these complex
members by sending a physician or nurse practitioner experienced in managing complex,
chronically ill to the member’s home to address their multidimensional
needs. Regular provider
visits are enhanced by INSPIRIS’ telephonic RN
Care Managers and Care Management Assistants
who educate, support and assist with
care plan compliance.
Unsurpassed Benefits
INSPIRIS CarePlus Improves Care and Lowers Costs
• Improved self-management capabilities and long-term problem-solving skills for effective
chronic disease management
• Improved adherence behavior that contributes to reduced acute admissions
• Improved long-term management of chronic issues
• Strong ROI
• 90-day implementation, early and strong results
• Reduced emergency room visits, reduced preventable hospitalizations and
avoidable re-admissions
• Comprehensive encounter data to ensure appropriate risk scores and revenues. Codes are
validated by a certified coder and submitted via the health plan preferred method.
Unparalleled Member Support
Members participating in the INSPIRIS CarePlus program benefit from care team interventions
that provide member-centered care and assist them and their caregivers with:
• Self-management education
• Triggers recognition
• Alignment of treatment goals
• Suggestions to improve home safety
• Medication management and adherence observations and suggestions
• Treatment plan adherence and coordination of care with primary care providers
Experience You Can Trust
The INSPIRIS CarePlus program leverages over a decade of extensive experience and a deep
understanding of the issues surrounding the care and care management of medically complex,
vulnerable individuals. This on-the-ground expertise, coupled with a Clinical Communications
Call Center, allows for rapid deployment of resources that result in early intervention and
treatment measures.
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