Health Plans and Managed Care

These services include:

• Preparation for achieving accreditation / reaccreditation from consultants with surveyor experience

• NCQA and AAAHC accrediting bodies for Managed Care and Health Plans

• Strategy development for quality improvement and performance improvement

• Customized operations and strategic consulting for your diverse membership base

• Mock Surveys for accreditation and reaccreditation

• Developing Health Education and Wellness promotion services

• Provider network access and availability analysis

• Member and provider satisfaction surveys

• Population needs assessment

• Utilization Management (UM) Program

• Chronic and complex case and disease management programs

• Adopting and monitoring network adherence to clinical practice and preventive health guidelines

• Implementation of Health Risk Appraisals (HRA)

• Delegation oversight of delegated entities such as Pharmacy Benefit Manager (PBM)

• Adopting clinical record standards for network providers

• Policies and Procedures for accreditation