Medical Management is Gateway’s hallmark service. It’s how we help our members live at their optimum level of health and wellness. It’s how we help employers reduce health plan expenses – which ultimately helps members reduce their out-of-pocket costs. Gateway’s Medical Management program has several components:

Utilization Review

Pre-authorization (Inpatient and Outpatient). During the pre-certification process, our members or physicians register future procedures or surgeries with our nurse staff under the direct supervision of the Medical Director. This gives us the opportunity to explore alternatives related to the particular procedure, whether length of stay, location, or cost re-negotiation. Furthermore, early knowledge of a procedure allows us to better direct care and to send educational materials that are extremely helpful to a patient and family members. Denials are authorized only by the Medical Director. A list of services requiring preauthorization is available to members upon request.

Case Management

This essentially can be divided into two areas: catastrophic case management and episode management. Both are extremely cost effective for our clients. After determining potentially high cost, high utilization cases through in-house analysis of usage data, our medically trained team assesses a situation then coordinates, monitors, and evaluates options and services. Quality, cost effective outcomes are achieved by meeting an individual’s health needs. Evidence of cost savings resulting from our case management is provided through customized reporting.

Maternity Management

Expectant mothers will want to enroll in Baby Plus - Gateway’s Maternity Management Program. Baby Plus is a proactive management plan designed to help mothers deliver healthier babies. The objective of Baby Plus is to reduce the severity and incidence of pre-term birth through early prenatal education and intervention. Gateway nurses assist the mother in understanding her condition and the vital role she plays as a manager of her health and the health of her baby. Baby Plus strongly supports the physician-patient relationship.
Baby Plus addresses the problems of high risk maternity and premature births through a comprehensive agenda that includes: