UM overlap final2.fw tracelogoRBEnsuring effective, cost-efficient care for your                        members.

 

For nearly two decades, our proven processes to manage utilization have improved quality and outcomes for your members while substantially improving our clients’ bottom line.

 

 

Our utilization management program reduces churning, medically unnecessary services and the high degree of variability in practice patterns that drive up costs. Our program includes financial incentives that promote effective, cost-efficient care while fostering adherence to the best clinical practices.

 

 

Through the use of performance-based tiers and administrative withholds, our program aligns incentives, penalizes under-performance and rewards the delivery of cost-efficient care.

 

HNS utilizes the provider’s average cost per patient as the metric to evaluate performance. Performance is measured monthly by comparing the provider's aggregate data against established industry benchmarks, and our reports include a comprehensive review of practice patterns, including all services provided to your members. The frequency and scope of our reviews provide meaningful and actionable data, allowing us to quickly identify costly outliers so that performance can be promptly addressed. Each month, performance is communicated electronically to all providers via  the HNS Comparative Practice Patterns Report (CPR). The HNS utilization management program improves quality of care for your members and reduces your spend. 

 

To learn more about HNS’ innovative solutions, click here.