Quality & Utilization Management
Utilization management is the analysis of costs and resources consumed in the delivery of health care and examines the relationship of actual practice to evidence-based medicine. The goal being the delivery of high quality, efficient, and timely services.
HVPA forms partnerships with local and national companies to negotiate exclusive discounts for our members on a wide-range of services. Some of our current partnerships include:
- American Profit Recovery–Debt recovery service
- Eagle Associates–Healthcare compliance consulting
- Hylant Group–Insurance brokerage and risk management solutions
- MD Wealth Management–Financial planning for physicians
- ProAssurance–Medical malpractice insurance
- Rehmann–Financial consulting and services
- Sage Solutions Group–Human resources consulting
- Staples–Office supplies
- Stifel–Retirement planning
- TAZ Networks–IT support
Michigan State Medical Society
HVPA and its physicians are an important strategic partner of the Michigan State Medical Society (MSMS). For nearly a decade HVPA and its physicians have enjoyed access to valuable MSMS benefits, including practice management resources, billing and coding support, and educational courses. More importantly, HVPA and MSMS are your strongest advocates during healthcare’s most turbulent times.
The Health Focus registry is a population health management tool that provides a comprehensive view of quality performance and patient-level gaps-in-care. The registry offers functionality as a point-of-care tool, performance dashboard, care management referral system, and as a longitudinal view of a patient’s medical history.
The system’s goal is to provide the most complete and accurate information available by leveraging the aggregation of dozens of clinical data sources from payer claims, hospital labs and admissions to provider practice management/EMR systems through the HVPA data warehouse. The system synchronizes with a number of commercial health plan pay-for-performance programs, allowing you to monitor and manage your performance for multiple plans in a single interface, simplifying the process of maximizing pay-for-performance revenue.
Aside from manual entry in a point-of-care setting, the tool sits on top of a data warehouse that has active data feeds from many external sources. These feeds allow for end-users to consume medical data beyond what occurs directly in the office.
Health focus not only consumes data but is also used as a hub to transfer information back to health plans and other organizations to ensure that our offices maximize their performance incentives. A direct connection to a practice’s EMR system reduces the need to manually enter data in multiple locations. This also allows the system to provide the office pay-for-performance value even if they never directly use the tool.
We have active supplemental feeds to Blue Cross Blue Shield of Michigan, Blue Care Network, HAP, and Priority Health. We continue to work with other groups as their programs expand to add additional feeds. The recent addition of a care management module has allowed for centralized care management services to be tracked and provided to our practices.
The tool is constantly evolving to adapt to challenges and initiatives in the healthcare domain. It continues to incorporate additional data through expansion of practice management system/EMR connectivity, regional hospital and post-acute care facility ADTs, and additional performance measures as organizations expand their focus on quality reporting.