Utilization Management – Health Central Services

Available with Diamond Pkg.Utilization Management

During the Utilization Management Review, high cost members will be identified and a plan will be established to reduce costs. A High Risk Patient Care team will be implemented in the search for better care for high risk members.

Consulting Packages

Main areas to improve.

Utilization Reports

Any business is governed by data that must be capture to give us a heartbeat of the companies success or any indication of failed processes. Do you capture any data by department? Moving numbers to produce positive outcomes is our specialty, but first you must have reports in place that you can review in a monthly and/or quarterly basis.

Hospitalizations

Yes, unfortunately patients get sick, really sick and require medical attention beyond what we can offer them. When the time comes and patients need to be hospitalized we need to have systems in place to avoid a readmission. Identifying high risk patients is a must in order to help them. We can help!

Clinical Pathways

The clinical pathway, also known as care pathway, is one of the main tools used to manage quality in health care in terms of standardizing care processes. Having clinical pathways in place for chronic conditions can save patients a trip to the hospital. We will work with medical director to create care pathways that can be utilize by your providers.

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DATA MININGWhat To Expect

This is the time to gather reports by department. We will be reviewing the EHR and creating tools to monitor employee productivity, and other utilization reports.

Opportunities for improvement will be identified. The goal is to create benchmarks and use resources efficiently, reducing costs, but providing high-quality care at the same time.

At the end of this stage, each staff member will have reports to run, the department head will track productivity, quarterly reports are ready, and decisions can be made with real-time data.

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