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Enhanced Health Options Plan (EHOP)
fThe Enhanced Health Options Plan provides utilization review and case management services across the continuum of care. Inpatient surgeries, as well as medical treatments, are monitored by a nurse case manager with expertise in a variety of specialty fields, including surgery, rehabilitation, home health, oncology, cardiac and emergency/critical care. This expertise gives Pathway the advantage of being more proactive. The case manager assesses options and data, educates the employee/patient, empowers the employee/patient to make informed decisions and advocates for them and their employer.
When the employee/patient has a need to utilize identified inpatient or outpatient services. they call Pathway first (unless it is an emergency). The case manager collects patient-specific information and contacts the provider, if necessary, to collect additional information to determine if the proposed procedure/service meets medical necessity criteria.
