by Bob Marcoux
Chronic illnesses such as diabetes, heart disease, asthma, COPD, and arthritis affect more than 60% of adults in the United States and account for approximately 90% of annual healthcare spending, according to the Centers for Disease Control and Prevention. As healthcare costs escalate and long-term disease burden grows, care management has become essential. Hines & Associates, a Global Excel company, delivers industry-leading care management solutions that directly address these challenges.
What Is Care Management and How Hines Enhances It
Care management is a coordinated, proactive approach to healthcare that involves planning, facilitating, and monitoring services throughout the patient’s care journey. It helps prevent gaps in care, improves continuity, addresses social determinants of health, and empowers patients to take control of their wellness.
Hines & Associates enhances this model through:
- Disease Management and Chronic Condition Programs targeting asthma, coronary artery disease, COPD, congestive heart failure, diabetes, and rheumatoid arthritis.
- Clinical nurse specialists and health coaches who collaborate with members to refine action plans, provide education, and ensure ongoing follow-up.
- URAC accreditation in Utilization Management and Case Management, validating the organization’s commitment to quality, compliance, and outcomes.
Key Merits of Care Management and How Hines Delivers
- Improved Health Outcomes
- Through early identification of risk and chronic conditions, Hines’ Healthy Tomorrows™ program uses data analytics, claim scrubbing, health risk assessments, and wellness services to slow disease progression and prevent complications.
- Hines’ Disease Management and Case Management teams deliver measurable results, reducing hospital readmissions and emergency visits through personalized interventions.
- Enhanced Patient Engagement
- Patients working with Hines’ wellness coaches receive tailored education and behavioral support to manage their conditions effectively.
- Member-centric guidance from nurse case managers promotes confidence, adherence, and informed decision-making.
- Consistent communication fosters trust and reduces the anxiety often associated with chronic illness management.
- Reduced Healthcare Costs
- Hines integrates Utilization Management (UM) and Out-of-Network Claim Negotiations to lower costs without compromising quality.
- Preventive and wellness-focused programs identify and address potential risks early, minimizing avoidable hospitalizations and high-cost episodes of care.
- Coordinated care eliminates redundancy and ensures efficient use of healthcare resources.
- Holistic and Personalized Care
- Hines incorporates behavioral health, wellness, and specialty case management in areas such as oncology, transplant, and renal care.
- Each care plan is designed around the patient’s goals, preferences, and life circumstances, including non-medical factors like transportation, housing, and nutrition.
- This holistic approach drives better long-term adherence and well-being.
- Better Communication Across Providers
- Hines promotes clear communication among primary care providers, specialists, and allied professionals through shared data and structured reporting.
- Nurse specialists serve as central coordinators, ensuring seamless transitions of care and eliminating gaps in service.
- The result is a smoother, safer, and more consistent experience for patients and providers alike.
Why Choose Hines & Associates
- Over 30 years of managed care experience and nationally recognized outcomes.
- URAC-accredited in Case and Utilization Management.
- Flexible partnerships that allow employers, TPAs, and health plans to select full-service or standalone programs.
- Proven savings, including more than $11 million in oncology-related cost reductions impacting over 1,400 unique individuals last year.
The Path Forward
As chronic illness continues to challenge healthcare systems nationwide, Hines & Associates offers a sustainable, patient-centered solution that shifts focus from reactive treatment to proactive and preventive care. Investing in Hines’ care management services means delivering measurable outcomes, reducing unnecessary utilization, and improving quality of life for members across populations.
Contact Hines & Associates today to learn how our care management solutions can support your organization and your members.
sales@hinesassoc.com
