Turn data into knowledge and then into action

Healthcare organizations are looking to save money while preserving patient choices and keeping office and information systems running at their best. When presented with thousands of pages of data, does your organization know how to find the nuggets of information? Is your pre-approval process reminiscent of voyaging into a mine field? Could you benefit from better educating your members and clients on ways to stay healthy?

HP Medical Management is a set of interdependent services that collects and analyzes medical information that translates into a competitive advantage. Our services help you improve health outcomes and optimize expenditures. Our services build on information collected by basic IT systems, such as claims adjudication, preauthorization and pharmacy services. You gain a full view of your client patient population to accurately assist them and care for chronic conditions and help them stay healthy with state-of-the-art wellness interventions.

Support to help you lower costs

Improve the outcomes of your care and achieve tangible cost savings by allowing our experts to provide your organization with Medical Management services. When you gain the ability to identify high-risk population segments, you can optimize heath care costs. As a result, timely interventions based on rigorous population stratification, predictive modeling, regression analysis and incident estimates become possible.

Your organization can improve health outcomes because of increasing insights into the optimal use of resources in the right areas at the right time. This addresses individual issues before they become more severe and helps avoid the development of costly co-morbid conditions.

You will be able to enhance healthcare services by providing clinical and scientific thought leadership and subject-matter expertise. Support the teams that are developing healthcare applications and services by offering them innovative approaches and alternative ways to look at data.


Medical Management Services

The Member Portal presents a unified consumer-centric picture of health to improve services and outcomes. It provides individuals with secure online access to their, as well as dependents’, personal health information, eligibility, and coverage. It also provides access to information such as claims, benefits or prior authorizations, spend-down tracking and third party activity. They can easily locate nearby doctors or review program and policy information.

Important broadcast information, such as where to get an H1N1 flu vaccination or incentives for wellness programs, can be accessed through the Member Portal providing an effective channel for communications for payers.

Collaboration is also woven into the healthcare portal framework where members can interact with providers such as their physician or case worker through joint reviews of health risk assessments and goals embedded in individual care plans.


Medical Informatics

Our Healthcare Provider Portal Solution coordinates member care and office administration tasks, allowing access to patient EHR, eligibility, claims, prior authorization and care management options through a member-centric approach. The HP Healthcare Provider Portal allows providers to determine benefit coverage, perform plan of care inquires, conduct basic drug searches and submit claims, submit appeals among other activities.

Through a member centric dash, providers can review at-a-glance member information and branch into more detail without additional searching. Providers can also begin claims, prior authorizations and appeals in context of the member and through pre-population of data into these transactions, resulting in efficiencies and increased accuracy for the provider.

Healthcare Provider Portal Solution is the hub of provider communication, offering both a secure mailbox for private correspondence and a channel for the provider to communicate both with the payer and with their patients.


Care Management Services

This service coordinates population health management for patients suffering from chronic conditions. Often, the coordination of chronic conditions is complex and requires integration of physicians, pharmacists, therapists and other providers.

Built on Medical Informatics’ historical and predictive analyses, Care Management uses insight into high-risk population segments to target cost-effective interventions that increase health quality and manage associated cost. HP’s Care Management solution consists of utilization management, disease management and case management.


Wellness Services

This self-directed service utilizes our Atlantes Care Management Solution which includes modern web-based assistance and assessments to gather information about staying healthy. Patients can learn about such topics as: smoking cessation, reducing personal health risks, maintaining an appropriate caloric intake, and safely increasing physical activity.

By getting health information from preferred partner sites, your members will gain credible knowledge that exceeds the quality of a blind hunt on a search engine. When patients answer a simple health risk questionnaire, they learn their current risk for chronic conditions such as hyper tension and diabetes.