HEALTHCARE QUALITY ASSURANCE

UniCare Healthcare Quality Assurance (HQA)* is designed to give our clients and members a bigger bang for the buck! Our HQA program offers the big things and the little extras that make a plan work and work well.

When members are informed and knowledgeable, they can make better choices. This may mean their own individual health is positively impacted, not to mention the health care system as a whole.

This educational approach also helps companies keep down their own health benefits costs overall. UniCare’s HQA program is an umbrella for many components of managed care that help maximize plan performance.

HEALTHWISE KNOWLEDGEBASE

Healthwise® Knowledgebase is an online resource available at www.unicare.com that provides members with valuable information on diagnosed conditions, medical tests, treatment options and key decision points.

HEALTHCARE ADVISOR BY SUBIMO

Healthcare AdvisorTM by Subimo is an innovative Web site that provides decision-making resources and information to UniCare members to assist them in better understanding their health care needs. It offers a variety of information, in an easy-to-use format, that members find useful when preparing for a medical procedure or managing a medical condition. Healthcare Advisor can also help patients research a hospital’s credentials, find information about treatment options, access questions to ask providers, search different drugs and understand generic alternatives and much more.

MEDCALL®

This toll-free 24-hour health information phone line provides members confidential access to answers pertaining to many of their health care questions. MedCall nurse counselors staff the hotline and provides members with information about many specific ailments, treatment options, prescription drugs and nutrition. Callers can also access the audio library, an automated health library with information on over 200 medical topics.

HEALTH IMPROVEMENT PROGRAMS

Many UniCare programs are designed to help members realize a healthier lifestyle, but for some, chronic illness is already a part of their everyday life. To help associates take more control of their chronic conditions and live a better, more productive life, UniCare offers Health Improvement Programs.

Unlike traditional programs that offer a one-size-fits-all standardized outreach and education approach, UniCare’s Health Improvement Programs focus more on outreach that is targeted toward the individual’s personal lifestyle. This concept, known as "Health Coaching," pairs a team of health professionals (which may include RN’s, dieticians, exercise physiologists, social workers, etc.) with the participant and their health care providers to decide which behaviors they would like to work on first. Then the participant receives education and support geared toward these goals. This program is not a substitute for the sound medical advice of your physician. The final decision about what program is appropriate for the participant is left to the individual and their physician.

MaterniCall®

UniCare's perinatal program, MaterniCall®, utilizes the health coaching model approach consistent with all of our Health Improvement Programs. Nurses specially trained in prenatal care are available to work with members to help reduce the risk of premature birth and to help facilitate healthy pregnancies and the delivery of healthy babies. The program promotes early and continuous prenatal care by providing education and support to expecting mothers. This program is not a substitute for the sound medical advice of your physician. The final decision about what program is appropriate for the participant is left to the individual and their physician.

UTILIZATION MANAGEMENT

Utilization Management (UM) helps members receive benefits consistent with the terms of their insurance or Health Maintenance Organization coverage. It monitors the care provided to detect patterns of over and under utilization, then works with practitioners and providers to improve the quality and use of covered services.

OUTPATIENT REVIEW SERVICES

UniCare reviews requests for elective procedures and diagnostic testing and works with the attending physician to determine if clinical data supports benefits coverage for the request. Requiring benefit pre-certification for certain outpatient services also helps identify members who would benefit from other HQA programs, such as case management and disease management interventions. This program is not a substitute for the sound medical advice of your physician. The final decision about what program is appropriate for the participant is left to the individual and their physician.

TRANSPLANT CENTERS OF EXPERTISE

This national independently contracted network gives members access to benefits for care at some of the best transplant-specialty facilities in the country. The Centers of Expertise are all leading, high-technology facilities, chosen for their experience and record of successful outcomes in each specific type of transplant. The program can also provide, in certain situations, additional support, including benefits for travel to these centers for the patient and a companion.

MEDICAL CASE MANAGEMENT

Through UniCare’s HQA program, case managers coordinate the special needs of patients with highly complex medical conditions to help the patients maximize health benefits. Patients may request case management services or a case manager may initiate contact based on data gathered through utilization review.

*The HQA program including all of its components do not provide medical, legal or tax advice. Members should consult their treating physician for medical advice. Members should refer to their legal or tax advisor for legal or tax advice. Some HQA components are provided by independent vendors not affiliated with UniCare or its affiliated or parent companies. The HQA program and components are subject to change or withdrawal without notice.

content