Impresiv Health can help bend the cost curve while improving patient satisfaction and clinical outcomes.

The constantly changing healthcare landscape presents an ongoing challenge for payers. You not only have to update clinical practices regularly to ensure your members are receiving the best possible care; you also have to focus on remaining profitable while improving patient satisfaction and meeting regulatory requirements. Fortunately, we designed our Medical Management Strategy Services to help you achieve this balance. Our services work across all lines of business, including government and self-funded payers.

With these customizable services, you can streamline internal processes and breathe life into your model of care to improve coordination of benefits, quality of care, and patient outcomes.

Model of Care Design

We build and implement new policies, procedures, and technology advancements across CM, DM, and UM for a more effective care management program.

Accreditation Management

We provide the clinical guidance to support your pursuit of state and federal regulatory compliance, whether you are already accredited or seeking reaccreditation.

Interim Clinical Leadership

If there’s a vacant position you need filled until a permanent solution is in place, we staff interim Clinical Directors, C-Suite, and Physician Executives.

Clinical Process Improvement

We drive improvement initiatives that focus on replacing inefficiencies with evidence-based best practices, ensuring your clinical operations unit is patient-centered.

Technical and Data Strategy

We guide you through the identification and implementation of the right systems and tools that drive an effective Medical Management program.

What does this mean for you?

Our Medical Management Strategy Services ensure your organization’s end-to-end internal processes align with a positive patient journey—without breaking the bank. Click through the tabs to the right to see how Impresiv Health can support the success of your clinical operations. Want to learn more? Feel free to contact us at info@impresivhealth.com.

Case Management

In addition to supporting your triple aim initiatives and identifying high cost members to guide them through better management of their health, we can also help:

  • Identify high utilization trends
  • Design plan-specific and evidence-based HRAs (Health Risk Assessments)
  • Design population-specific clinical guidelines
  • Create and revise policies and desktop procedures
  • Business process and workflow design
  • Implement policy to adhere to state, federal, URAC, and NCQA guidelines
Population Health

Implement a patient-centered Population Health Management program to meet your population’s needs. Impresiv Health can support with:

  • Design of advance care planning
  • Identification of key requirements for predictive modeling
  • Integration of your population health and care management functions
  • Addressing social determinants of health
  • Physician and member engagement initiatives
  • Business process and workflow design
  • Improving plan data to support your PH strategy
  • Implement policy to adhere to state, federal, URAC and NCQA guidelines
Utilization Management

We promote the use of evidence-based guidelines to ensure medically necessary treatment, timeliness of UM determinations, accurate claims payment, and monitoring of contract requirements. When you partner with Impresiv, we support the need to deliver high quality care that’s cost efficient. We can also help with:

  • Fine-tuning your prior authorization list
  • Utilization management business rule design
  • Interim Medical Director support
  • Business process and workflow design
  • Implement policy to adhere to state, federal, URAC and NCQA guidelines
Appeals and Grievances

When it comes to appeals and grievances, we understand the priority of remaining compliant while addressing the needs and concerns of your patients and physicians. We can help you with:

  • Clinical documentation improvements
  • Interim Medical Director support
  • Business process and workflow design
  • Implement policy to adhere to state, federal, URAC and NCQA guidelines
Quality

Whether you are seeking improved Star Ratings or HEDIS quality measure performance, Impresiv Health can guide and support quality improvement initiatives such as:

  • Improvements to plan data to support your QI strategy
  • Clinical documentation improvements
  • Business process and workflow design
  • Implementation of policies to adhere to state, federal, URAC and NCQA guidelines