Applying life care planning principles in acute situations

Abstract

In autumn of 2004, a US stop-loss carrier requested consultation regarding their in-house catastrophic case-management program. Their market was self-funded Employee Retirement Income Security Act (ERISA) plans with fewer than 10,000 lives. Although the company was committed to providing case management, they had problems with data gathering and communication with various third-party administrators (TPAs) for lack of a consistent flow of work and communication among all parties concerned. Their question: “Is case management provided by a stop-loss carrier viable in this circumstance?”