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ThinkHealth's utilization management tools provide valuable insights into your members and business.

Health plans typically approve nearly all utilization management (“UM”) requests, so we used clever technology to enable ThinkHealth to automate determinations and interrogate each utilization management transaction to feed disease and proactive care management programs, shape patients’ care plans, and uncover member, provider, and financial trends that may be shaping your business.

Our UM system handles pre-authorizations, pre-certifications, referrals, concurrent reviews, retrospective reviews and extension requests, appeals, discharge planning and much more. Also, it provides configurable, self-monitoring UM workflow functionality and integrated clinical criteria for UM workers involved in reviewing complex requests. Moreover, ThinkHealth includes an “auto-determination” engine and letter generation system that automatically determines requests based on hundreds of configurable rules. Our automation, along with interfaces that enable consumers and providers to make requests via the Web, can process and generate letters regarding millions of requests simultaneously with little or no manual intervention.

Of course such productivity gains drive hard dollar returns to your business, but ThinkHealth doesn’t stop there. The system leverages the information from the utilization management process to add to a continual stream of member data from other rich sources to shape each patient’s care management plan in real time. Consequently, care managers receive up-to-the-moment information and instructions they need to more effectively and efficiently manage each patient’s care. No time is wasted, and no one falls through the cracks. They can see at a glance how different conditions and health episodes correlate, for a better understanding of exactly what drives costs.

With ThinkHealth, your patients are managed better. And so is your business. ThinkHealth's utilization management tools provide valuable insights into your members and business.