InsurHealth

Our mission

Bridge the Gap between Insurance Companies and Healthcare Organizations through Unified and Collaborative Services in the InsurHealth Network.

Bridge the Gap between Insurance Companies and Healthcare Organizations

Restructuring Injury Claim Processes and Settlements  Has Never Before Been 
More Innovative. Efficient. Unified.

CaseMed Solutions, LLC created InsurHealth Affinity Group, LLC to better unify the insurance and healthcare industries. We are on a mission to provide the best holistic solutions to injured persons, whether they occur under workers’ compensation, automobile/vehicle liability, medical malpractice insurance coverages, or private payment.

The InsurHealth Network is purposely built on an ecosystem business model that offers a subscription-based annual membership and network equity-ownership to all approved members.

InsurHealth promotes a cross-industries members advisory council which will have a board seat along with the founding members.

Financially, the equity members will be treated as partners for tax purposes, receive K1s and distributions as declared by the board.

Please read through the website, ask questions and JOIN US!

About us

Services ->

Our InsurHealth Objectives: ‍

To Leverage InsurHealth’s Integrated Network Member Services.
To Facilitate Member Business Growth: Financially, Geographically, Resources & Services Capacity, Local, Region, Member Partnerships, National Customers and Healthcare Innovations.
To Nationally Improve Patient Holistic Patient Healthcare and Recovery Outcomes.

InsurHealth promotes a cross-industries members advisory council which offers a board seat along with the founding members.

Financially, the equity members will be treated as partners for tax purposes, receive K1s and distributions as declared by the board.

How InsurHealth Addresses Health Industry Problems

InsurHealth’s mission focuses on the total holistic rehabilitation of the injured person serviced by its members. InsurHealth also recognizes the cross-industry challenges that impede InsurHealth members' successful holistic rehabilitation of injured persons under their care. Our mission is to mitigate those challenges and make holistic rehabilitation possible.

Traditional Way

InsurHealth Solution

Insured or Self-Insured Risk Manager

Risk Manager works with claims organizations to rehabilitate injured employees to return to work—within insurance/corporate policy cost parameters.

InsurHealth customizes claims programs with Risk Managers and preferred Claims Organizations. Objectives:

Meet Business & Insurance Needs.
Higher Healthcare Service Quality.
Cost Effectiveness.

Insurance Defense Attorney

Defense Attorneys represent organization policies, focusing on loss costs and entity intervention.

InsurHealth invites Defense Attorneys & Claims Management to its Data-Sightline Claims Triage^SM

Program.

Goals:

Reduce Loss Costs.
Close Claims Faster.
Enhance Injured Person's Claim Award via Structured Settlements to support the Injured Person's financial and rehabilitation needs for future years.

Personal Injury (PI) Attorney

PI Attorneys represent claimants to ensure that a fair deal is made with the Defense Counsel on behalf of the injured person concerning a Claim Award. At the same time, the PI Attorney will try to bolster the largest award possible without going to trial. The PI Attorney receives 33.3% of the insurance award (even more if the case goes to trial) that is awarded to the injured person.

InsurHealth’s Nurse Case Managers live by a Code of Ethics & Fairness to the injured person whose needs are central to legal interactions. Balancing the motivations of the Defense Counsel and PI Attorney law firms constantly challenges InsurHealth, allowing the Injured Person to achieve the best financial and healthcare outcomes possible. When faced with opposing counsels, InsurHealth recommends:

Collaborative & Objective Injured Party Life Care Planning.
Involving an approved Nurse Case Manager, and using InsurHealth’s Data-Sightline Claims Triage^SM Program.

Nurse Case Manager’s Collaborative Role

Nurse Case Managers are skilled Registered Nurses (RN), assigned to injury claim cases by a Claims Adjuster. In a typical case management setting, Case Managers are limited in terms of their resources and ability to work with different aspects and members of the care team. With InsurHealth, members can reach out to the Network and find specialized services that make case management easier and more effective.

InsurHealth Nurse Case Managers are the point of coordination of care services for self-insured company risk managers and Claims Adjusters. The Nurse Case Manager engages InsurHealth's National Healthcare Providers' specialized services available in the network to support coordination of care needs.

Goal: Collaboration of care activities with the Adjuster.

Nurse Case Manager’s Coordination of Care

Coordination of Care. Nurse Case Managers take on the responsibility of working directly with the injured party and medical staff to develop coordination of care strategies with claims, medical providers, and in some cases with the insured or injured party’s family. The goal is always to provide the best services to holistically rehabilitate the injured party.

Coordination of Care. The InsurHealth mission is to provide holistic rehabilitation and healthcare. InsurHealth Nurse Case Managers know that holistic is a combination of mind, body, spirit/soul, and emotions. This means that if a Nurse Case Manager informs claims that the injured party needs some or all of these coordination of care activities, they should be taken seriously.

Goal: Coordination of care strategies with the Adjuster to achieve the most viable holistic outcomes possible.

Claims Adjuster

Adjuster workforces are most often understaffed with large claim volumes. New Adjusters can take years to become seasoned Adjusters. Developing good and lasting relationships with Nurse Case Managers (and vice versa) can optimize the Adjuster’s workflow, processing efficiencies, and positive outcomes.

The InsurHealth Data-Sightline Claims Triage^SM Program can be a critical success factor in leveling the workload with external professional support. InsurHealth’s triage program helps locate accurate claim reserve settings, claim process journey activities, and structured settlement options throughout the claim process to accelerate claim closures. Given the challenges that claims management may have, at times with the lack of or new Adjusters, the InsurHealth triage program provides the Adjusters “line-of-sight” on the claim’s journey. InsurHealth Claims will introduce the triage program and work with the claims management throughout the claim journey to generate the best outcomes.

Hospital Registered Nurses

All motivated registered nurses infuse “the heart of medical patient care” when treating hospital and medical clinic patients. We call this passion, “The Heart of a Nurse,” and it is this passion along with the nurse’s varied medical experiences that InsurHealth aims to make available to the InsurHealth Nurse Case Management member companies for hire.

It’s been our experience that Registered Nurses that join CaseMed Solutions, InsurHealth’s founder, specifically working as Nurse Case Managers, have sought to use the talents and compassion they learned in hospitals and medical patient care more in consulting (i.e., field registered nurses) than hospital systems management. This is especially true with workers’ compensation claim work. Hospitals will need Nurse Case Managers as an outsourced resource and opportunity is strong for both hospital systems and nurse case manager involvement upon the hospital’s EMR systems.

Medical Data Analytics

Medical data analytics, if available, can provide claims organizations and nurse case managers a guide to support the Adjuster's claim processes and the Nurse Case Manager's coordination of care activities for all parties involved in the rehabilitation and healthcare of the injured party. But good medical analytics data is limited today.

Medical data analytics is a core component of the InsurHealth Data-Sightline Claims Triage^SM Program. InsurHealth has a national alliance with Medical-Legal Solutions (founded by Care Bridge International), an actuarially recommended medical (AI/ML) data analytics firm. Medical-Legal possesses over 16 million+ workers' compensation claims data analytics database.

Claim Award Structured Settlements

Claim structured settlements are only leveraged in claim settlements 20% of the time, with cash award payments 80% of the time. Statistically, cash awards are completely used up by the injured party in 5 years on average. Since the injured party's need for continued rehabilitation services and financial support can easily extend beyond 5 years, and in some cases for decades, Defense Attorneys, PI Attorneys, and Claims need to encourage injured parties to accept Structured Settlements over cash-only awards.

InsurHealth has a national alliance with Arcadia Settlements Group, a leading structured settlements company and a key player in the Data-Sightline Claims Triage^SM Program. The program is a trifold of InsurHealth nurse case management (ala CaseMed Solutions), Medical-Legal Solutions, and Arcadia. InsurHealth leads the program with the nurse case manager’s relationship with the Adjuster on a claim file. The information is shared among the partners and provided to the Claims Adjuster to begin adjusting. The Nurse Case Manager updates the case information and shares the monthly report with the triage team to present results to claims.

Industry Networks/Alliances

Both insurance and healthcare industry networks and alliances ("Industry Networks") are a fact of life today. The general business purposes are to expand products and services, reach new markets, and generate new revenue streams. Some challenging characteristics of today’s industry networks include:

Consolidations of businesses and markets
Reductions in customer services and personal contacts
Business ownership challenges; and more

The InsurHealth Affinity Group Network is uniquely different from other and more traditional industry alliances and networks. Differences include:

A collaborative membership of like companies.
A more unified mission of insurance and healthcare companies on the holistic rehabilitation of injured persons.
Offering equity ownership to all members and an integrated network economy inside an ecosystem business model.
Multi-tiered national industry ecosystem membership of insurance and healthcare entities. All members bring their individual ecosystem partners into the InsurHealth Network to create a national membership revenue feeder system among the members.
Total ownership of the InsurHealth Network by its members.

FAQs

Frequently asked questions ordered by popularity. Remember that if the visitor has not committed to the call to action, they may still have questions (doubts) that can be answered.

Still have questions?

What are my commitments if I join InsurHealth?

The primary commitment is to participate in the Network’s member activities while maintaining your current business activities. This will help you grow your business and develop collaborative relationships with other members.

InsurHealth is established for its members to continue their normal business operations and commitment to their existing customers while taking advantage of the InsurHealth Network member services.
Encourage your company’s ecosystem business relationships to join InsurHealth and broaden the Network.
Grow your business through financial interactions with other members of the Network and contribute 10% of intermember financial transactions to the Network.
If agreeable, become a General Equity member to share in the ownership of InsurHealth.

Can you identify other ecosystem businesses that I might recognize?

A few examples of U.S. ecosystem businesses are: Microsoft, Google, Tesla, CISCO, IBM, Apple, and Amazon.

‍Effective ecosystem strategies can deliver valuable near-term benefits as well as generate long-term growth and resilience. Leaders are finding significant benefits already.

Listen to the Audio: Growth and resilience through ecosystem building
‍

What are the financial and operational benefits of being a General Equity member?

The financial benefits are best described on the website’s Investment Opportunities Page. For onboarding operational benefits, please see below.

We will provide onboarding sessions for all members to orient themselves and their staffs to InsurHealth’s MS Dynamics CRM (supported by Alta Vista Technologies) to upload the members’ company information, geographical reach, staff expertise, and service offerings. The CRM process allows the member to be visible to other members for business transactions and collaborations. The CRM also possesses MS Power BI to assist the member and management to data analytics within the Network.
Onboarding also includes information about how InsurHealth’s financial and transactions accounting works through the Gravity Software system (supported by JRMR Consulting). Gravity is a cloud-based system with a higher level of operational capabilities for InsurHealth than QuickBooks. Included in this onboarding session is instructions on member-to-member financial transactions training.
For members interested in licensing, use licenses with GuideSmart^SM Nurse Case Manager workflow software, onboarding, and training will be provided.

Tell me more about how InsurHealth is different in terms of providing Holistic Rehabilitation and Healthcare to injured claimants than what we do today.

Today’s healthcare system is broken in many ways. InsurHealth’s mission is to put a finer focus on being more patient-centric by concentrating on the coordination of care that results in holistic rehabilitation of the injured claimant. Today the quality of our healthcare systems is defined in terms of “Efficacy, Effectiveness, and Efficiency” see [Efficacy, Effectiveness and Efficiency in the Healthcare Industry: The Need for an Agreement to Clarify its Meaning]. These qualities are important, however, many times the healthcare system manages its financial needs without truly focusing on the full wellness of patients. InsurHealth’s mission brings more of a “Ministry” approach to treating injured persons and a healthcare rehabilitation approach to wellness. Our approach evaluates the total patient’s needs in terms of coordination of care and services that address the “Mind, Body, Soul, and Spirit” of the patient, covering all physical and mental challenges caused by serious injuries.

Still have questions?