Sleep Management Utilization and Quality Management

With more than 18 million people suffering from obstructive sleep apnea (OSA), studies show that a high percentage of these patients also have the following co-morbidities:

• 80% of drug resistant hypertensive
• 35% of hypertensive
• 50% of atrial fibrillation
• 50% of congestive heart failure
• 30% of coronary artery disease

CareCore Sleep Management utilizes research-driven clinical expertise to improve quality and reduce inappropriate utilization.  We employ innovative information technology, data management systems, and evidence-based clinical pathways to deliver financial and clinical value to payors, patients and providers.

Utilization Management
Data has shown that the demand for solutions to OSA is going to exceed the standard medical trend over the next five to ten years.  In fact most market studies have shown payors seeing year over year claims expense growth of anywhere from 20-40 percent.

Understanding the need for health plan members to receive appropriate care, CareCore Sleep Management's Utilization Management employs several programs designed to ensure accessible, quality care. The components include:

• Prior authorization for diagnostic and therapeutic services
• Cost-effective and clinically appropriate diagnostic redirection programs
• Therapy procurement, distribution and patient management
• Medical equipment distribution and therapy delivery
• Compliance monitoring and educational initiatives

Quality Management

Leveraging the evidence-based criteria developed by Sleep Management Solutions, the CareCore Sleep Management Quality Management Program uses clinical pathways to ensure patients receive appropriate, unfragmented care. These clinical pathways guide the management of patients requiring sleep studies and sleep therapy management.