Managed Care Organizations

///Managed Care Organizations
Managed Care Organizations2018-08-14T17:26:04-06:00

Health Plans, TPAs, MSOs, IPAs

Managed Care Organizations are looking to address one of the most challenging questions facing healthcare today—How can we improve quality of care and overall population health while bending the healthcare “cost curve”?

HMS Essette’s integrated Care Management platform helps MCOs manage quality, cost and compliance across all lines of business including the Medicare, Medicaid and Commercial plans.

Designed from the ground up to support Care Coordination across the continuum:

  • Comprehensive suite of applications built on the same platform facilitates cross-department collaboration and reduces training costs
  • License model supports unlimited users at no additional fee so all constituents can participate in coordinated care
  • Advanced web architecture allows access on any device with a browser means care support by any user at any time on any device
  • Fixed-fee license model provides peace of mind & predictability knowing that software costs won’t rise as your organization grows
  • Software built to stay ahead of market trends using input from cutting-edge clients, industry consultants, and HMS Essette’s own clinical experts
Essette Core Modules

HMS Essette Software Modules

Framework based on NCQA Complex Case Management Guidelines Designed based on criteria and standards from NCQA, the CMSA, and experienced nurse case managers. Kept up-to-date through input from clients, the market and industry, and HMS Essette’s own clinical experts.

Combines analytics with a comprehensive campaign designer to engage consumers in wellness and health promotion programs.

Supports efficient management of authorization requests and inpatient stays. Embedded auto-approval rule engine and tight integration with evidence-based guidelines ensures timely, appropriate and cost-effective care.

Allows organizations to comply with regulatory requirements regarding member and provider appeals by automatically creating a ‘To-Do’ list with due dates.

Allows providers to participate in collaborative care management, including the ability to auto adjudicate authorizations.

Highly configurable BI tool that doesn’t rely on IT to support with customizable dashboards, user-friendly report builder, charts and more.

Industry leading analytics tool built into the industry leading population health management platform.

One-stop shopping portal gives customer service reps the ability to provide consumers and providers the immediate answers they require.

Streamlines and automates inbound and outbound communication.

Learn more about HMS Essette software features.

Our clients fly through audits!

We continuously review and incorporate NCQA, URAC and CMSA’s Standards of Best Practice. We also stay abreast of CMS and state requirements ensuring full support for key programs including Medicare (MA & FFS), Medicaid, SNP, Dual Eligible, PACE, etc…

Equally important, HMS Essette listens to nurses. The result is “audit ready” software that is extremely user-friendly – ensuring both user satisfaction and regulatory compliance.

HMS Essette software is built on an advanced, modular architecture using ‘bricks’ of code, making it possible to rapidly modify, configure, and integrate the components needed to meet unique business requirements.

Have you ever played with LEGO® bricks? Then it’s easy to imagine how adaptable HMS Essette’s software is: solid software templates that, when ‘snapped in place’, allow clients to create their own work flows and meet industry standards.

Technology flexible enough to allow for changing regulations and business requirements — software so agile, it can be reconfigured within days, not months; content-ready, but configurable enough to match each client’s unique business rules.

Interoperability has always been our passion and demonstrated expertise. In fact, we’ve been waiting for the industry to catch up to our belief — you can’t have true coordinated care without integrating information from across the continuum.

HMS Essette brings together information from a wide variety of sources, and makes that information available to coordinated care teams in ways that cannot be accomplished in legacy EMR, Registration, Financial or Claims systems. We are capable of leveraging vital organizational tools, including existing eligibility/claims systems, analytics, and portals—eliminating dual data entry and providing a complete 360 degree member view of all information needed to provide truly coordinated care.

HMS Essette Integration supports standard clinical and administrative industry formats:
– HL7 transactions for ADT, CCD/CDR exchange and other clinical data import
– ANSI X-12 HIPAA EDI transactions for auth, eligibility and claim detail
– Direct SQL Server and flat file imports

HMS Essette Integration also supports new and emerging formats:
– HMS Essette published and 3rd party APIs for direct application communication
– EMR and Hospital systems integration using HL7 SMART on FHIR

HMS Essette comes with a complete starter set library of pre-built care plans and clinical content allowing our customers to be up and running very quickly with minimal effort.

Incorporating a broad set of evidence-based references, HMS Essette’s clinical experts have pre-configured the application with rich set of clinical content:

– 25 assessments with branching logic
– Condition specific automated programs for Asthma, COPD, Depression, Diabetes, Heart Failure, Medication/Treatment adherence
– Over 40 pre-built reports
– Almost 40 correspondence letter templates
– One or more care plans for each of the following areas:
– Advance Directives
– Adherence
– Asthma
– CCM
– COPD
– Depression
– Diabetes
– Diet
– Heart Failure
– Hypertension
– Self-management
– Smoking cessation
– Substance Abuse
– Transitions
– Utilization
– Workers’ Comp

HMS Essette clients can also choose to license seamlessly integrated evidence-based content from our strategic partners.

A Unique Alternative

HMS Essette offers a robust highly customizable alternative to ‘shrink wrapped’ applications. Our web-based solutions help users streamline workflow, comply with regulatory requirements, and most importantly, improve patient care outcomes.

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