Utilization Management

Our Utilization management suite, integrated with MCG’s CareWebQI supports Precertification, Predetermination, Admission Review, Discharge Planning, Medical appropriateness, Monitoring throughout continuum of care, and Provider performance


Lowering cost while maintaining quality

In- and out-of network provider detection, early identification of high cost events, identification of emerging high risk members, and evidenced based quality of care: all leading to cost containment without compromising quality.


Control Excess Utilization

Benefit design, inpatient and outpatient review, high cost procedure management and ER and admission review, with proper discharge planning and transition of care, out Utilization management solution helps prevent excess and duplicate care, thus allowing for an optimal use of scarce and expensive healthcare resources.


Proactive Care Coordination

Care coordination, health risk assessment, outcome-oriented alerts and gaps in care, including drug interactions leading to comprehensive assessment of patient needs; Subsequently allowing care team members to proactively engage with the patients to work for and with them throughout the continuum of care.

Clinical Decision Support

  1. Medical appropriateness
  2. Continuous monitoring (follow patients throughout the continuum of care)
  3. Reports to see trends and performance in utilization savings and impact of care and disease management programs
  4. Benefit design
  5. Admission Review
  6. Discharge planning and transition of care
  7. Focus on high-cost, high utilization procedures.

Work-flow Optimization

  1. Care plans, Care scheduling, Care notifications, outreach and correspondence
  2. Case and disease management
  3. Care notification
  4. Medication reconciliation
  5. Patient Engagement: Alerts and automated messaging
  6. Coordinate patient care around a care team – Proactive interactions between care team members and patients

Cost effective outcome

  1. Work for and with the patient throughout the care delivery system
  2. Ensure right care at the right time in the right place
  3. Care based on evidence based and clinically accepted guidelines
  4. Meaningful interpretation of data to prevent waste and excess utilization of services
  5. Inpatient and outpatient review to maximize patients’ medical benefits
  6. Management of High-cost procedures and user friendly and express pre-authorization process to help control expenses.