Who is MedExpert?
MedExpert International, Inc. is a privately held medical decision support company with headquarters in Redwood City, California – the heart of Silicon Valley. MedExpert currently serves more than 4.5 million clients in government, labor unions, private corporations, and school systems.
Since 2012, MedExpert has been assisting Medicare members throughout the United States as part of an Innovations Award from the Centers of Medicare and Medicaid Services. The vetting process for this award was extensive, involving review of the MedExpert model by more than 700 individuals and 100 review committees. MedExpert was one of just over 100 awardees chosen from among 3,000+ applicants, and to this day is considered by CMS a leading project because of the great success MedExpert has shown in reaching and assisting Medicare members, as well as reducing costs and emergency room visits.
The MedExpert Model
The MedExpert model includes traditional case management incorporated with innovative technology that seamlessly engages with members and their health care providers. The model is primarily telephone-based that may also use real-time video image, including FaceTime and Skype, text messaging and/or email. Although the technology is modern, MedExpert is effective in retaining deep involvement with members. To further assist in improving the health of the member, MedExpert collaborates with the health care providers and other resources available in each community. State and local agencies, hospitals, doctors, pharmacies, behavioral health providers, social service agencies, and others are integrated into the MedExpert model.
MedExpert is supported by state-of-the-art technology. Their Quality Medical Management System (QMMS) is a customizable platform engineered to meet the information and medical management needs of both the member and medical care teams.
QMMS supports narrow or broad health initiatives through a proprietary dynamic evidence-based medicine system knows as Individual Medical Decision System (IMDS). IMDS offers customized, evidence-based information rapidly delivered to individuals through MedExpert’s doctors, nurses and medical information coordinators. IMDS covers medical conditions (greater than 22,000 medical conditions) and all pharmaceuticals in every phase of clinical status.
Combined, MedExpert is capable of providing members with the services they need such as immediate phone access to MedExpert doctors, information about available services, medications, and health care conditions, access to preventative health care, and many more. By focusing on case management, collaborating with providers, utilizing new technology, and assisting members to make smarter and better decisions, MedExpert aims to be successful in helping to improve the health of members.
How the MedExpert Model Works
MedExpert will regularly contact members, either through their outreach or when members call the toll-free number with medical questions or concerns. In either case, members will be able to immediately speak with a MedExpert representative.
If AMCCI members have a medical question, they can call MedExpert for guidance and support. MedExpert uses on-staff doctors and registered nurses to help answer health care questions and manage each member’s case by directly working with them. Both members and their health care providers may access MedExpert’s doctors directly.
The doctors are also supported by MedExpert’s Medical Information Coordinators (MIC) who will provide concierge and patient advocacy support to members. The MIC’s come from various backgrounds. Most are nurses, but MedExpert also employs some MIC’s with healthcare insurance and claims experience. MIC’s training on MedExpert policy and procedure, and highly engineered system is extensive and geared to maximize their effectiveness in working with doctors and with members to improve their health care.
What MedExpert Provides
Services to AMCCI members
MedExpert will provide members with the following:
· Immediate access to MedExpert doctors and nurses
· Assistance to understand medical conditions
· Assistance to understand medications
· Facilitating resolution of health care problems and concerns
· Providing information about available health care resources
· Choosing the appropriate setting for health care
· Support to obtain and access the health care needed
· Assistance to make appointments
· Facilitating access to community resources for transportation, food, housing, and other assistance
· Coordinating with health care providers and community resources
· Health promotion i.e. living a healthy lifestyle
· Care transition
Initially, MedExpert staff will call members to introduce themselves, and provide information about the AMCCI program and case management services. During these early contacts, MedExpert will aim to establish rapport and a mutual understanding of the member’s health conditions, concerns, and barriers.
Next, MedExpert will perform an initial screening to determine a member’s needs. This initial screening will assist in identifying and prioritizing the member’s most urgent needs so those services are made available as soon as possible. During this process, MedExpert will also assure the member has selected a primary care provider, a pharmacy, a hospital and a behavioral health provider, if indicated.
After the initial screening, each member will receive a comprehensive health needs assessment based upon clinical and psychosocial histories, and individual member preference. This assessment aims to create a person-centered written care plan which is shared with the member and the member’s family, the member’s primary doctor, pharmacy, hospital, behavior management provider, and other parties identified by the member. The care plan will also address other factors such as substance abuse, domestic abuse, homelessness and mental illness, and identify other barriers the member may have in obtaining the needed health care.
Although MedExpert staff do not make decision for members, they will support members to be well informed and make appropriate medical choices. During the consult, MedExpert doctors and team will review the member’s health history, perform assessments, and develop the plan of care. MedExpert will also reach out to the experts for more information about the member’s condition and set up appointments for the member with the appropriate specialists.
The MedExpert model DOES NOT replace the member’s doctor—it provides support to both the member and providers to improve the member’s health status.
Coordination with Providers
MedExpert will initiate contact with medical providers to promote and assure appropriate coordination of the member’s plan of care. At a minimal, MedExpert will communicate and coordinate with providers to assist members with:
· Medical regimen compliance
· Keeping appointments
· Arranging appointments for problems that member encounters
· Identifying new symptoms or problems
· Medication compliance
· Appropriate use of ER services and visits
· Prescription information and usage
· Tobacco use cessation
· Other coordination activities
Coordination with Community Partners
MedExpert will also facilitate access to community resources that impact members’ health and access to health care. These services may be beneficial to the member such as public assistance and other community partners for support including food stamps and child care, utility assistance, housing, transportation, and financial management resources.
How to Contact MedExpert
Members, providers and other agencies can contact MedExpert by calling their toll-free number during their standard hours of operation:
· Hours: Mon - Fri, 7 a.m. to 7 p.m. (Alaska Standard Time)
· Website: http://www.medexpert.com/results.html