Development of an effective utilization management program at Celtic Life Insurance Company

Celtic Life Insurance Company's (Celtic) utilization management program demonstrates that insurance companies, like hospitals, can develop a high level of quality assurance in utilization management by maintaining a professional clinical staff, developing special programs to target specific medical concerns, and conducting ongoing audits. Celtic's High Risk Maternity Program, developed in 1988 as an adjunct to the utilization management program, provides education about pregnancy and childbirth, screens pregnant insureds, and offers case management for high-risk pregnancies. Pregnant insureds who volunteer to case management are referred to the Rose Bud Program, a premature labor prevention program that was developed by Northwestern National Life Insurance Company with Abbott Northwestern Hospital.