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If not effectively managed, member utilization and ineffective care coordination can significantly increase the expenses of a health plan. Consequently, a health plan must be proactive in identifying members with chronic illnesses and diseases, as well as promote employee wellness programs. Structured policies and procedures for monitoring member care are crucial. Conduent’s HSP Care Management program facilitates effective and efficient utilization management, care management and disease management programs.

HSP Care Management is fully integrated with our Core Claims Administration solution. It improves the proper use of services by utilizing user-defined, template-based authorizations and referrals. HSP Care Management assures the timely review of services through pre-assigned workflows and case management integration, leading to improved assessment, outcomes and clinical benchmarking.

HSP Care Management allows you to:

  • Identify members with chronic diseases and specifically engage them
  • Utilize authorization tools
  • Customize case and authorization reports to allow you to offer what your users need
  • View medical claims, diseases, pharmacy scripts and lab data
  • Create and manage content workflows through all programs
  • Integrate time management and reporting
  • Leverage your own clinical content or use our integrated view of Interqual or Milliman criteria
  • Administer user-defined Health Risk Assessments and other questionnaires
  • Customize schedule tasks for follow-up based on a variety of criteria including diagnoses, claims, or other user-defined criteria
  • Access real-time productivity and operational reports as well as integrated claims data for advanced analytics
  • Exchange data electronically for authorizations, lab, and pharmacy information
  • Provide a Web interface for providers