MANAGED CARE PRACTICE
TAC assists public purchasers to successfully utilize managed care to design prudent purchasing and performance contracting systems.
TAC's specific expertise includes:
- Analyzing and evaluating the impact of changes in state and federal regulations on business processes and policies.
- Helping purchasers make informed, cost-effective decisions about the necessary infrastructure and competencies required of their provider networks to meet the demands of the changing behavioral healthcare landscape.
- Assistance developing medical necessity criteria, clinical authorization policies and procedures, and service performance standards (e.g. program specifications).
- Identifying current service needs and gaps, outcome measures, quality indicators, and appropriate payment methodologies.
- Reviewing utilization management (UM) practices to identify opportunities for quality improvement and cost effectiveness, and recommending strategies to implement and evaluate improved UM practices.
- Recommending clinical pathways to less intensive levels of care that are consistent with high quality care in a recovery environment.
- Creating strategies to improve crisis system functioning and reduce emergency room presentations and inpatient utilization.