Our early intervention program, Ultimate Care, connects claims, medical and bill review data to transform claim outcomes.
Proactive Care. Powerful Analytics. Predictable Price. Proven Results.
No matter how powerful AI or analytics may be at identifying and predicting risk, it’s not nearly as effective without connecting often disconnected data. Ultimate Care breaks down data silos by connecting claims, medical, and bill review data to deliver comprehensive risk profiles for every claim, at every step. Using proprietary risk-scoring and monitoring technologies, early intervention measures, and the strategic application of integrated services, Rising’s program:
- Continuously evaluates profiles and instantly identify changes in risk
- Targets high-risk cases early
- Reduces claim severity and duration
- Shortens return-to-work timeframes
- Decreases claim expenses
- Results in optimal patient care and outcomes
- Provides predictability to care management costs with one fixed rate per case
- Gets to the ultimate cost of a claim faster, with less expense
Act on Risks Before They Become Realities
From the start, Rising’s registered nurses use proven risk assessment tools to conduct employee interviews. Risk predictors are factored into our proprietary risk-scoring algorithms to tag higher-risk cases and implement early intervention strategies. Cases are then subject to continuous data mining and monitoring to ensure that emerging problematic claim activity is flagged for action and employees are rerouted to the most appropriate care pathway.
Medical Concierge Approach
Key to our ongoing claims oversight is Ultimate’s medical concierge-style services that focus on patient advocacy. We drive optimal outcomes by providing injured employees with upfront and ongoing support so that unnecessary medical, indemnity, and legal costs are avoided throughout the claim lifecycle. We do this by:
- Ensuring the right doctor and treatment are provided at the right time
- Coordinating preventive intervention and proactive care
- Managing referrals to surgical specialty providers
- Helping employees avoid the dangers of drug and opioid addiction
- Supporting employees with a “go to” clinical resource
- Controlling costs before they become excessive
High Touch, Low Cost
Our proactive approach will also trigger additional interventions as necessary — such as injury care coordination, telephonic case management, surgical care management, and direction of care (as appropriate) — without incurring additional costs, as all of these services are included in Rising Ultimate’s one flat case rate.
From ensuring that seemingly straightforward med-only cases don’t become indemnity cases to providing extra assistance on higher-risk cases, Rising Ultimate’s strategic application of resources and services effectively steers the course of your claims portfolio at a predictable cost.
