Well, it was another fine "Fireside Chat" for the AIMM staff this past weekend. One of the topics we covered was Chemotherapy. Of course, I don't want to give away all our "secrets", but I thought this might be an appropriate forum to share some key things that AIMM does differently than other medical management vendors when handling cancer cases:
1 - AIMM uses only RNs (and MDs too, but never laypeople, never LPNs, etc...)....recently a new client joined us, and the previous medical management vendor had an LPN handling Case Management on a cancer patient. I'm not entirely certain that it was just the fact that the Case Manager was an LPN, but I feel pretty sure that her being an LPN certainly contributed to her handling of the case (and the fact that she didn't recognize that the plan of treatment was worthy of aggressive questioning / experimental / not a covered benefit).
2 - AIMM investigates the following on every chemotherapy agent: Name of the drug being utilized, route/administration method, dosage, for the treatment of what specific type of cancer, and at what billed cost. We also investigate FDA approval status of the medication (as it is being used (dose, route, single/combo agent, etc), and for the condition it is being used to treat).
3 - AIMM investigates & communicates with patients and providers about whether there specific plan design considerations/constraints - For Example: what if there are no FDA approved drugs for this type of cancer (because it's a rare type, as an example)? What if this is an "off label" use of an FDA approved medication? What if this is a clinical trial? We feel strongly that patients deserve to have all the facts up front - cancer is devastating enough...they don't need any payment surprises happening 3 to 12 months from now!
4 - AIMM uses a variety of methods to ensure that the billed costs coupled with any applicable discounting (aka PPO discounts) results in the cost of the medication being reasonable (close to AWP).
5 - AIMM ensures that the patient has every possible resource at their disposal, including facilitating use of community resources, obtaining case reviews from experts, accessing governmental (and other) financial assistance, and providing an enormous amount of both verbal and written education items.
6 - AIMM ensures that contact happens with the patient - we never close a cancer case simply because we can not reach the person by phone - instead we will seek out assistance from the designated plan representative to assist us in connecting with the patient. (We once discovered an identify theft situation because of this - our patient's identity had been stolen, and was being used by someone else who was seeking cancer treatment. Had we not gotten the plan representative to assist us in connecting with the member (the member had ignored out telephonic outreach to her because she was healthy and didn't feel she needed us), we (and she) would never have known that the person getting cancer treatment wasn't really her! Her lifetime maximum would have been used up by an identity thief!
These are just a few of the ways that AIMM is "special" when it comes to handling Cancer and Chemotherapy cases. If you would like more information, please feel free to contact me! (I'm sure you noticed that there are 6 reasons, when the title says "5 reasons"....that's because AIMM always strives to give you more than you expected, and to "under promise over deliver" - not just in Cancer Case Management, but in everything we do.)
PS - Nurse Kelli was the presenter for the chemotherapy fireside chat. It was her first time doing a presentation like this. She did an AWESOME job, we all learned a lot :-)
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