Eliminate Inappropriate Care – Improve Clinical and Financial Outcomes
To deliver the best care possible to members and to use healthcare dollars most effectively, it is critical to ensure that the care being delivered is:
- Medically necessary
- Appropriate
- Aligned with clinical best practices
Suboptimal healthcare services can compromise members’ health and waste limited resources.
Focused on identifying and removing unnecessary and redundant care, and promoting clinical best practice, APS Utilization Management and Review services leverage our deep experience and clinical foundation to fully understand your healthcare delivery systems and processes to recommend and implement services that will work with your systems, facilities, and providers.
Designated by CMS as a QIO-like organization, we design programs that are effective in identifying was in your unique delivery system. Our UM services can be implemented independently or in tandem with our population health management services. Services include:
- Prior authorization and preadmission certification
- Concurrent review
- Retrospective review
- Focused reviews
- Discharge planning and reporting
- High-risk care coordination
