Medical Management Evaluation and Optimization
While much of the organizational attention in today's MA plans is focused on administration, the majority of plan expense (and, should it bear mentioning, the justification for managed Medicare at all) is in the effective coordination of care. Yet for many plans, this vital function has become diffuse and ineffective in recent years.
Plans must return focus to monitoring enrollees health status, both upon enrollment and periodically throughout the plan year, managing chronic diseases, avoiding inappropriate hospitalizations and helping beneficiaries move from high risk to lower risk on the care continuum. To do this, plans must also be very savvy in data collection, data measurements and reporting.
Is your organization ready and able to:
- Ensure quality though every step of the care continuum?
- Promote appropriate utilization of medical services ?
- Ensure early identification of chronic conditions and disease states
- Respond to changes in member satisfaction
- Optimize Plan resources
A health plan’s medical management strategy should provide consideration for medical management options such as:
- Health Risk Assessments
- Concurrent Review
- Admission Notification
- Discharge Planning
- Prior Authorization Request Review vs. Post Service Review
- Case Management/Disease Management
For more information on how GHG can help you evaluate, design and implement a Medicare Management program, please contact us at (202) 364-8283.
