Coordination of Care Program Support Services

SEC provides commercial health plans and federal and state programs support services for identifying opportunities to improve the coordination of care and implement intervention strategies to achieve cost savings:

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  • Identify unnecessary costs

  • Improve quality of care

  • Medication use management

  • Disease and care management

  • Address disparities

  • Identify and classify patient safety issues

  • Identify and classify access problems

  • Measure cost and quality success

SEC Client Services

  • Conducting a baseline health plan claims analysis with periodic updates to identify patterns of uncoordinated care using criteria-driven algorithms that apply a new method for risk stratification based on the highest potential for impactable cost savings and quality improvement (regardless of severity of illness or number of diseases) and characterize specific contributing factors identified.

  • Converting claims level data into patient specific, actionable information profiles that are transmitted directly to the provider(s) at the practice level via secure messaging.

  • Mapping uncoordinated patients to existing care providers for planning and implementation of interventions, care/disease management, and care coordination activities and programs.

  • Evaluation and retooling of existing systems, utilization management and intervention programs to develop and apply common criteria, procedures and systems for enrollment and monitoring of targeted patients with the most cost and quality improvement opportunities.

  • Implementation of new delivery models, pay for performance programs/strategies and expanding existing educational and intervention programs for identified patients to improve care coordination within medical home models, accountable care organizations and other payment and delivery models to promote value driven health care.

  • Integration of existing and new technologies to improve efficiency and patient outcomes, such as electronic health information exchange systems, e-prescribing, secure provider messaging, and other web-based provider monitoring and practice management tools.