right care, right place, right price
SHPS utilization management ensures that costly services and procedures are medically necessary, provided within benefit plan guidelines and performed in appropriate settings – cutting down on wasted healthcare resources. It can decrease claim trends associated with inpatient acute-care hospital admissions, sub-acute care admissions, outpatient procedures, surgeries and other therapies. Reviewing these procedures saves significant costs and identifies at-risk participants for additional intervention, such as discharge planning, care coordination and case management.

balancing supply & demand
Consumer-driven healthcare works best when adequate supplies match appropriate demands. SHPS utilization management provides oversight with this goal in mind, offering a proven, immediate way to reduce healthcare costs without restricting needed care. And as participants in consumer-driven plans take greater control of their healthcare dollars, their interest in such programs will increase.

full-service flexibility
Rather than investing time and resources in creating an in-house program, partnering with SHPS utilization management leverages our expertise to meet the demands of your customers. SHPS utilization management includes discharge planning and care coordination as standard components, rather than buy-up options like most competitors. This continuity of care management prevents complications and further hospital admissions. Our flexibility can meet your specific needs, including pre-notification rather than full medical-necessity review to identify participants for disease or case management programs. And we offer full integration with other care programs, providing a seamless experience for your participants.

SHPS utilization management offers our partners:

• complete administration. SHPS handles everything from pre-authorization to final appeals. Our approach includes reviewing medical necessity, seeing that care is provided within plan benefits, ensuring appropriate settings (e.g. in-patient vs. out-patient facilities) and network channeling or redirection.
  
  
• choice of review criteria. You can use our standard list of procedures for review, or a custom list of conditions prevalent in your organization based on historical data.
  
  
• integration with other care programs. SHPS utilization management can integrate with nurse lines and disease/case management – allowing you to identify and intervene with at-risk participants to lower their future health risks.
  
  
• full and accurate reporting. Our actuarially valid financial reporting gives a clear and accurate picture of your organization’s savings.
  
  
• speed-to-market. By partnering with SHPS, your organization can quickly add a best-in-class utilization management product to your portfolio – achieving short-term cost savings without the long-term costs of building one yourself.