Care Management

You'll hear it often from Nippon Life Benefits: We believe in treating our customers with honor, respect, and dignity. Care Management is just another way we show it.

Nippon Life Benefits offers, Utilization Management, Case Management, and Disease Management solutions. These targeted solutions help pinpoint "at-risk" employees - or those who need extra help. Our care management solutions are supported by:

• Evidence-based decisions - ensuring employees receive the right care at the right time.
• Integration and technology - cohesive systems that help identify (and support) as many employees as possible.
• Targeted outreach to employees - direct contact with employees who have complex medical needs.

Utilization Management

Health Information Line is a confidential telephone service staffed by professionals trained in the insurance field. These professionals can access employees' coverage information through our computer network, and are able to provide:

• Benefit advice
• Hospital preadmission authorization
• Non-emergency stays
• Hospital stay extensions
• Emergencies
• Maternity delivery

Case Management

Case managers are there from plan development to implementation, offering early risk identification, assessment, monitoring, reporting, and outcome measurement. Our case managers review the following :

• Hospital preadmission authorization
• Non-emergency stays
• Emergency care
• Maternity delivery*
• Hospital stay extensions

*Subject to mandated length of stay

Disease Management

It's a fact: Most medical costs incurred are for chronic diseases. When employees are able to properly manage these conditions, it helps employers control future health care costs.

Healthways, Inc. is an established disease management provider that assists employees with managing:

• Diabetes
• Coronary Heart Disease (CHD)
• Chronic Obstructive Pulmonary Disease (COPD)
• Asthma
• Impact conditions
  (Arterial fibrillation; fibromyalgia; inflammatory bowel disease; irritable bowel syndrome; low back pain; osteoarthritis)

The program is managed by dedicated assigned nurses to:

• Contact all eligible members
• Provide educational tools
• Communicate with physicians

Healthways disease management services are available for groups with 50+ employees who have chosen certain PPO networks.

"Active Health" Integrated Medical Management

Participants in the Aetna Signature Administrators^sm network can take advantage of the "Active Health" Integrated Medical Management program. Solutions include:

• Pre-admission authorization
• Large case management
• Utilization management

Large Case Management/Utilization Management services include:

• Management of complex illnesses and injuries that require intensive nurse management
• Ensuring that members receive appropriate health care services at the right time, for the right length of time and in the right clinical setting.
• On-going utilization management applied to all inpatient and select outpatient services planning
• Improving the quality of care received by members by taking a proactive approach to intake and discharge planning protocols.