In managed care, especially Medicaid, outpatient therapy (Physical, Speech, and Occupational Therapy) is susceptible to significant overutilization.
The root cause of the overutilization is a lack of clinical evidence to drive informed UM decisions. When health plans are not armed with actionable data, it is difficult for them to approve the most appropriate Plan of Care. In turn, providers take control of visit frequency and duration. Overutilization ensues.
Reducing fee schedules, shrinking the network, and arduous UM processes only provide a temporary fix.
Health Network One uses an alternative payment methodology - a severity-adjusted fixed payment - that shifts the emphasis from visits and units to ensuring the member is properly diagnosed with the most appropriate Plan of Care.
Our commitment to this differentiated and holistic approach delivers tangible economic, operational, and clinical value:
Since 2005, we have been building and enhancing once-in-an-industry capabilities. Through our unique provider reimbursement methodology and expert utilization management team, we deliver significant medical cost savings while expanding member access, building provider loyalty and ensuring the highest level of clinical quality.
Outpatient Therapy is experiencing explosive cost growth. Health Network One can manage this unique specialty for your organizationContact Us