Focus Area: Care Management
As healthcare premiums continue to rise; consumers shoulder a growing share of healthcare costs while taking on the management of their own healthcare decisions. Consumers require the tools and guidance to make informed healthcare decisions based on the costs and quality of care. Simultaneously, health plans are looking for new ways to control expenses without impacting the quality of care within the boundaries of continually evolving regulatory requirements. The traditional permission-based medical management programs are giving way to integrated care management programs that focus on early detection, prevention, and wellness and join together the health plan and health care delivery system.
HTMS clinical consultants assist health plans to meet the challenges of the new consumer centric environment, understand the impact of evolving regulatory requirements, integrate the healthcare delivery system, control healthcare costs, and improve the quality of care. Our care management team offers a full range of services, which include:
- Clinical operations optimization
- System selection, procurement and implementation services
- Integrated care management systems (UM, CM. DM, Medical Appeals and Wellness)
- Predictive modeling
- Clinical and consumer decision support
- Clinical coding tools
- Clinical strategy, definition and execution
- Accountable care organizations
- Patient centered medical home
- Health Home
- Medicalloss ratio
- Provider portal
- ICD-10 clinical impact
- Health Plan/ Health Care Delivery System Integration
- Integrated care management vendor market analysis
- Interim staffing for key positions
- Assistance with state and federal grant applications for clinical pilots
