Care and Utilization Management Services

care-utilization

Our personnel have extensive experience in providing consulting, data analysis and clinical services for utilization review/case management in both Medicaid and commercial fee for service and managed care programs. We provide the services of licensed pharmacists and professional staff with extensive experience in clinical and economic evaluations to meet the requirements of the contract. We also provides evaluation and assessment regarding the quality of care participants receive as a result of drug therapies based on treatment guidelines and best practices and other clinical intervention and educational support provided for enhancing clinical outcomes.

  • Coordination of Care Program: Opportunities for Savings and Improved Outcomes in Commercial Health Plans and Federal and State Programs
  • Improving Program and Health Plan Design to Reduce Uncoordinated Care, Save Money and Improve Quality
  • Program Cost Containment and Quality of Care Strategies
  • Care and Utilization Management Experience

  • Disease management and health outcome evaluation initiatives
  • Clinical and therapeutic criteria selection and evaluation for utilization review programs
  • Pharmacy and medical service utilization review and intervention protocol design
  • Patient pharmacy compliance monitoring plans
  • Development and implementation of provider and patient  education and intervention programs
  • Design and implementation of medication therapy management programs
  • Educational training programs for disease management, DUR, and compliance monitoring
  • Evaluation and dissemination of practice guidelines and treatment algorithms