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Medical Management

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Critique is a healthcare advocate with a unique perspective.
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Health Utilization Management

Critique, Inc. provides medical management to assist individuals, who have health concerns, with support along the way. Nurse case managers assist in managing the delivery of medical services during the acute phase of an illness or injury.

Chronic health or catastrophic health conditions are identified from information received from a patient, hospital, doctor, family member, client or payer. If a hospitalization is involved, contact is made with the hospital to confirm the hospitalization and to determine that the treatment plan is appropriate.

Where advisable, the Nurse Case Manager may recommend further monitoring and intervention and offer assistance to prevent hospitalization from occurring or re-occurring. We assist employers, as well as individuals, in saving money by preventing hospitalization.

“Once Critique, through MBA, was engaged in our medical management efforts, we found that there was a substantial difference in the year-end results due to lower total claims. This difference was result of fewer hospitalizations & shorter stays as well as improved medical risk in on-going illnesses. These factors created very comfortable renewals for our clients.” 

—William R. Greer, CIC, President, Greer & Assoc.

Participants are contacted by a Registered Nurse Case Manager to perform a more detailed Health Risk Assessment and discuss general health and compliance issues such as:

  • Diet
  • Exercise and therapy plan
  • Medications (prescribed, over-the-counter, natural)
  • Activity level
  • Physician instructions
  • Last physician visit
  • Current or ongoing assessment testing
  • Safety

Beneficial intervention helps prevent flare-ups of conditions that may require hospitalization.

Critique provides these services for employer groups all across the country.

“Critique works with them [employees] to improve their health, which obviously improves the “health” of our medical plan as well. As we have compared our self-funded rates against the market, we quickly found that our costs are well below rates offered through the insurance carriers. ...they have made every effort to engage individuals who may have medical risk markers to do the things that improve their own health. Clearly the results show up in lower claims cost.”

Todd Rawle, Vice President, Check City

MBA identifies and recommends participants for the NurseMonitor program through:

  • claims payers, based on claims with certain documentation;
  • prescription card company reporting;
  • inpatient stays due to conditions that can be improved through medical management and;
  • Risk scores from the Health Risk Assessment tools.
Health Utilization Management
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