UTILIZATION MANAGEMENT CONSULTING
Control Hospital resources with our Utilization Management Consulting
Novia Strategies recognizes the key role that physicians and clinicians play in controlling hospital costs. We work with your physicians and clinical staff to develop balanced quality and cost critical thinking into their daily patient care decision making processes so that the right care is delivered at the right price. We lay a foundation for accurate, reliable data and evidenced based practice information for physicians and clinicians to use while making patient care decisions. This information, coupled with cost/quality balanced decision methods, provide the insight physicians and clinicians are looking for to help them provide the care the patient needs while simultaneously being good stewards of the patient’s health care dollar. Finally, Novia Strategies works with the hospital to create metrics and reports for ongoing insight and improvement. With this methodology, we get you results beyond what your organization can do alone.
Novia Strategies prides itself on providing a team of seasoned, credible consultants who understand how to partner with your physicians, clinicians and fiscal managers to drive unnecessary costs out of care. Our consultants are expert at analyzing and presenting data so that information can be used in critical decision making by physicians and clinicians. We lay the foundation to motivate physicians and clinicians to truly partner with the fiscal managers to drive costs out while ensuring quality care is maintained and actually enhanced. The right level of care is found when cost and quality are effectively balanced and the gains are sustained when our consultants build a bridge between clinical and fiscal collaboration.
BENEFITS OF OUR UTILIZATION MANAGEMENT CONSULTING SERVICES:
We will work with you to develop and implement strategies that result in:
- Appropriate use of inpatient, outpatient, ancillary and support services
- Optimized use of hospital resources
- Physician involvement and knowledgeable management of resources
- Maximized authorization for coverage (prospective, concurrent, and retrospective)
- Educational resources for staff and physicians
- Educational tools for patients
- Enhanced discharge planning
- Maximized use of referral network and resources
- Outcome tracking and monitoring tools and reports
- Enhanced effectiveness of UM organizational structure and roles
- Compliance to UM guidelines, regulatory, and accreditation standards
OUR APPROACH – UTILIZATION MANAGEMENT CONSULTING SERVICES:
We utilize a four step process in our consulting which is tailored to the level of support you need. These four steps typically are as follows:
- Assess your utilization management system or specific areas identified and make recommendations for improvement
- Develop an action plan to guide the improvement work for either your team or a combined hospital-consultant team
- Provide Implementation support through project leadership and/or hands-on support as needed
- Provide an operations dashboard and training that allows the organization to monitor and ensure the gains are maintained.
Assessment Planning and Implementation
Phase One – Assessment: Optional areas of focus during our Assessment:
- Authorization process and timelines
- UM organization structure
- Variations in delivery of care
- Utilization of resources
- Medical Record review for documentation of relevant information
- Staff and physician knowledge base
- Medical staff roles and involvement
- UM reports and monitoring processes
- Regulatory and accreditation compliance
- Continuum of care and referral resources
- Policies and procedures
Phase Two – Key Components of our detailed Action Plan:
- What work needs to be completed to get the improvements targeted
- Who is on point for each activity/outcome
- Identification of key considerations for success
- By when should work occur with attention paid to both prioritization and sequencing
Phase Three – Implementation Optional Support Available:
- Strategic leadership to assist in positioning and managing barriers
- Project leadership to drive the work to completion
- Utilization Management Subject Matter Expert support:
- to provide insight into best practice
- to share various approach options and lessons learned from other project experiences
- to provide objectivity
- to challenge the status quo
- Staff support to do the work in organizations where resources are tight
Contact Us to learn more about our Utilization Management Consulting Services.
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