The Solution

Medical Management

• Medical Team Reporting –



Medical Management – SHS helps Medical Management teams to make intelligent decisions about in-sourcing and out-sourcing care management resources, more accurately predict future member health, automate proactive management of enrollees, and monitor Medical Management program participant eligibility. Quality Improvement – SHS helps QI teams to determine the burden of illness in a book of business to prioritize medical programs, population health management initiatives, and wellness and preventive care initiatives. SHS provides the tools to analyze the effectiveness of internal teams and vendors in managing the health of members and reducing costs. Utilization Management – SHS helps identify utilization trends and unusual treatment patterns that may require additional management attention, and compares treatment alternatives from a cost and quality perspective.

• Employer Group Reporting – Allows medical management to understand the disease burden of specific groups and members.
• Population Health Management Tools – These tools are specifically designed to support efficiency and coordination among care teams to provide high-risk patients the optimal care at the appropriate time and in the appropriate setting.

• Provider Profiling/Report Cards – SHS helps Network Management teams build high performance networks/ performance tiers that provide optimal quality for anticipated cost by supporting Pay-for-Performance and physician tiering based on the cost and quality of the services they provide. SHS tools also monitor physician compliance with nationally accepted evidence based medicine (EBM) guidelines and provide analytics that allow for the unbundling of the various costs of rental network management services.
• Employer Group Reporting – SHS tools help Network Management teams build provider panels that optimize the utilization of specialty care providers to better manage the disease burden of the population.
• Management Reporting – SHS tools help develop the plan’s network and specialty ratio based on the disease burden of the book of business