HS1 offers a comprehensive array of medical management products and services to health plans, insurance companies and self-funded groups. 

We have experience in the medical management of over 200,000 lives comprising  Medicare, Medicaid and Commercial lines of business.

Medical Direction

• HS1 Chief Medical Officer and Medical Directors have extensive managed care backgrounds
  
• They insure that the highest quality of care is delivered in the most cost effective manner
  
• They promote direct involvement with Physicians, PCPs, Hospitals and Discharge Planners
  
• Specialty-oriented Peer Review Committees oversee episodes of care, grievances, credentialing,  etc.

Disease Management/Population Informatics

• Evaluation of high-risk patients for appropriate DM programs
  
• Identification of members at risk of substantially impaired health status and potentially more serious problems
  
• Case / Disease managers follow patients concurrently with PCP & Payor with focus on preventative care
  Care is directed to appropriate specialist
  
• PCPs are assisted in management of their patients
  
• Reduces costs associated with chronic illnesses
  
• Provides educational information to patients and family on how to control or reduce chronic conditions

Authorization Department

• Treatment Auths. -  24 / 7

• Benefit & eligibility verification

• Timely referrals to specialists and hospital for inpatient and outpatient services

Concurrent Review

• Coordination of all inpatient care - from hospitalization to discharge

• Specially trained RNs assist in the timely provision of in-patient services including:
  - Professional consultations and reports
  - Laboratory and diagnostic procedures & results

Case Management

• Upon discharge, Nurses manage the total continuum of care

• Insure that the most appropriate, cost effective & timely treatment is provided

• Services include:
  - Home Health / Physical Therapy
  - Durable Medical Equipment
  - Skilled Nursing / Custodial Care

Credentialing

• Delegated to HS1 by Plans

• Primary Source Verification

• In-house Peer Review

• Integrated with QI program

• Comprehensive record keeping & documentation

Quality Improvement

• Evaluation of Providers for Regulatory Compliance

• Information trending / tracking

• Benchmarking & Corrective Action Plans