CBCA patient-centric care management approach identifies potential gaps in care through
early intervention based on patient needs. Nurses work with patients and physicians to determine the appropriate level of care, care setting, and continuing care needs. CBCA's
Care Management program is based on principles that have yielded a 3:1 to 5:1 return on investment for employers.

Precertification, Medical & Behavioral Health

Our URAC-accredited utilization review services - preadmission certification, concurrent
review, in-patient and out-patient management and retrospective review - ensure
appropriate care and medically-necessary treatment is performed in appropriate settings
before costly, unnecessary claims occur. We collaborate with providers using evidence-based guidelines to help ensure members are receiving the correct care in the correct setting.
Nurses guide members to appropriate network practitioners and facilities. Cases are referred
to Case Management and rates are negotiated when out-of-network care is unavoidable, minimizing wasted healthcare resources for members and the plan. Our process covers both medical and behavioral health in-patient and out-patient services.

Acute & Complex Case Management

Complex Case Management is an outreach initiative to engage members and/or their
caregivers in intensive case management to support and assist them with interventions
designed to stabilize their conditions and facilitate services needed to maintain medical
and psychosocial stability. Complex Case Management focus is on those members who are
largely unable to fully care for themselves or manage their illnesses. Our multidisciplinary programs are geared to support members who are experiencing chronic, debilitating life threatening illness that will benefit from active and aggressive interventions to return the members to the maximum possible health status and quality of life.

Chronic Care Management

This program is designed to effectively transition identified members from complex to
chronic and, if appropriate, end-of-life care management services. It will also continue the
"whole-person" approach using universal and condition specific surveys to identify gaps in
care, implement target interventions and educational efforts with a focus on:

• Empowering the member to manage their own condition

• Reducing barriers that prevent compliance to medical guidelines and the physician's treatment plan

• Reducing and eliminating complications

• Focusing the nurse case manager on clearly defined interventions and outcomes

Maternity Management

Complications during pregnancy can be frightening, confusing and costly. Healthy
pregnancies result in fewer complications and preterm births, higher birth weight, less absenteeism, and reduced claim costs. Mothers-to-be enrolled in CBCA's Maternity
Management Program may avoid many complications associated with pregnancy. We offer support by educating mothers-to-be about their pregnancy and how to avoid risk
throughout the pregnancy.

Nurse Help Line, 24/7 with Extensive Audio Library

The Nurse Help Line is a triage, advice, referral and health-counseling service that
provides employees and their family members with around-the-clock access to registered
nurses. Using guideline-based assessment tools, our nurses have access to both the PPO network and consumer-focused healthcare information. The Nurse Help Line operates from
a URAC accredited call center. Results show that clients experience up to a 37% reduction
in the incidence of emergency room visits, a similar reduction in urgent care visits and a
42% reduction in unnecessary physician visits.

Wellness

From early identification to active management, CBCA’s wellness program addresses the
entire health of our member population. Our wellness program is aimed at improving health, promoting wellness, and managing healthcare through telephonic and web-based interaction between members, care providers and care managers. To learn more, please click here.

Cancer Treatment Validation

Studies show that 15% of diagnoses are incorrect, 25% of treatment plans deviate from guidelines, and 45% of patients do not comply with prescribed treatments. CBCA's Cancer Treatment plan reduces inappropriate use of drugs and radiation therapy, improves network efficiency, and in the most serious condition promotes early use of hospice and palliative care
in end-of-life situations. When available, our program validates and facilitates the appropriate participation in high quality clinical trials.