With EPOCH’s Care Management Solution, traditional utilization review (UR) and large case management (LCM) are augmented with additional cost management tools that result in even more savings for our clients, and better quality health care for the member. EPOCH uses predictive claims modeling technology to identify:

      •  Forecasted high cost patients, their expected services, and estimated costs
      • Itemization of these predicted services and costs that can be impacted through case management          and/or our disease management program

Predictive modeling allows EPOCH to surpass the typical triggers for large case management. For example, we are able to identify those individuals who are non-compliant with industry recommended guidelines but have not yet incurred an inpatient stay, a trigger diagnosis, or a high dollar claim. In addition to using this tool for case management, employees with chronic diseases are identified for the disease management program. Disease management incorporates both written and verbal messages, tailored for each individual’s specific needs and demographic group. Members with chronic conditions complete a survey, allowing us to assess their self-management skills in conjunction with the severity of their illness. EPOCH’s program is designed to educate members, and then engage participants who are ready and willing to make a change in their behavior and self-management skills. “Red Zone Participants”, (the highest risk participants) are also assigned a large case manager to act as their personal coach. The 24 hour nurse line and member website (EPOCH Access) provide members with additional access to critical information, when they need it.