Best Utilization Management Software in South America - Page 2

Envolve is committed to transforming healthcare by leveraging strategic partnerships and extensive experience to deliver value-based and cost-effective care solutions. The services offered by Envolve MSO equip organizations with essential strategies, skilled personnel, and streamlined processes aimed at implementing value-driven, affordable healthcare and facilitating genuine transformation in the sector. As a prominent provider of healthcare management services, we infuse innovation and expertise to enhance performance within outcomes-oriented and value-based reimbursement frameworks. Our comprehensive healthcare management services improve both quality and efficiency in care delivery through top-tier business administration services, effective data usage, clinical excellence, and robust operational support. By investing in pioneering benefit designs across a variety of products nationwide, Envolve significantly contributes to publicly funded, marketplace, and commercial programs that enhance individuals' health and overall quality of life. This commitment to innovation and improvement positions Envolve as a leader in reshaping the future of healthcare for all.

naviHealth is revolutionizing senior-centered care by collaborating with health plans and providers to enhance the care transition process through innovative technology. Our focus is on simplifying transitions and improving overall care experiences for seniors, offering valuable news, insights, and expert analysis. With our proprietary tools for post-acute care planning, naviHealth provides clinical support that not only boosts patient recovery but also minimizes avoidable medical expenses. Our approach allows partners to manage care transitions more effectively, utilizing our specialized patient care management system. By integrating in-market clinical support with cutting-edge technology, we facilitate a smoother recovery journey for patients, enhance satisfaction levels, and reduce unnecessary costs associated with post-acute care. Furthermore, naviHealth’s dedicated care coordinators play a crucial role in maintaining seamless communication among patients, their families, and healthcare providers, ensuring that everyone is on the same page throughout the recovery process. This interconnected support system ultimately leads to better health outcomes and a more efficient care experience.

We provide a diverse array of thorough products and solutions, developed by experts in the field who elevate online systems, data, and tools to an advanced level. Our budget-friendly system is designed to enhance patient flow, thereby boosting productivity, performance, and the overall patient experience. Spend more time focusing on your patients instead of managing your computer tasks. Our solution effectively reduces absenteeism, presenteeism, and disability challenges within your organization. With our system, you can make a significant impact by enhancing the monitoring and promotion of your services. We are committed to assisting you in caring for the elderly population. The tools we provide are essential for improving both the effectiveness and efficiency of your operations. Our team conducts in-depth analyses and develops tailored solutions that meet your specific needs. As healthcare technology specialists, we comprehend and communicate in the language of healthcare. Our platform minimizes administrative tasks, allowing you to dedicate more time to patient care. We believe that any technological advancement that contributes to human betterment should be shared for the collective good. Together, we can create a healthier future for everyone.

Prioritizing the front end is essential for enhancing the overall patient financial experience and optimizing revenue cycle outcomes. By implementing cohesive front-end solutions, organizations can effectively address deliverability issues, significantly reducing the occurrence of returned mail and unpaid invoices. It is crucial to minimize input errors by accurately verifying patient identity and demographic details. Additionally, confirming insurance eligibility at the point of service plays a vital role in maximizing revenue while ensuring compliance with regulations. To streamline processes, automating prior authorization from start to finish within seconds can lead to improved efficiency. Furthermore, automating notifications guarantees that payers receive timely updates regarding inpatient hospital admissions. Clear and precise communication of patient out-of-pocket expenses also contributes to better financial transparency. By assessing patients' propensity to pay and their eligibility for financial assistance, hospitals can enhance their collections. Once a secondary concern, patient access is now recognized as a pivotal element in healthcare facilities. Our adaptable platform harnesses the power of integrated data from various verification sources, coupled with intelligent guidance, to create a comprehensive solution. This integration not only fosters better patient access but also drives overall organizational effectiveness.

Our comprehensive platform provides fully integrated health plan solutions that add value and reduce the complexities of healthcare for employers, members, providers, and payers alike. Valenz combines member-focused services with insights derived from data, creating connections through personalized assistance that leads to high-quality care and enhanced outcomes. We prioritize early and frequent engagement through effective education, support, and services designed to prevent more severe and costly health issues down the line. By choosing Valenz, you can foster a healthier member population while consistently achieving cost savings for both plans and members year after year. To access the transparency and tools necessary for making quality-driven, cost-effective decisions, let’s discover your pathway to more efficient healthcare today. Additionally, the Valenz healthcare ecosystem optimization platform features a suite of fully customizable solutions that are all integrated within a single strategic framework, providing in-depth visualization of cost, quality, and utilization opportunities, ensuring you are equipped to navigate the healthcare landscape effectively.

Collective aggregates patient information into a streamlined alert system, enabling emergency department providers to make quick and well-informed decisions that enhance patient outcomes. Alerts regarding patients who exhibit patterns of excessive service use or intricate needs are dispatched immediately upon their registration—additionally, these notifications reach other members of the care team, allowing for timely interventions and guiding patients toward more suitable care options to prevent inappropriate use of emergency services. Collective's notifications are integrated seamlessly into various systems, regardless of the electronic health record used, or can be delivered through alternative methods such as fax, network printers, email, or text messages. This adaptability to the distinct requirements and workflows of each facility fosters collaboration among providers, equipping them with a unified strategy—ensuring that the collective support remains with the patient at every step of their journey. Ultimately, this approach not only enhances communication but also promotes a more efficient use of healthcare resources.

An integrated hospital management system serves as a comprehensive solution for all operational tasks within a healthcare facility, with a strong emphasis on creating a paperless environment while streamlining management processes. By leveraging current technology trends, we ensure that users can access the system from any device, thereby enhancing overall efficiency. The system is designed to reduce the workload for clients, enabling them to perform their duties more effectively and achieve faster, more accurate results. To utilize the hospital software application, users simply need a web browser and an internet connection, which allows for accessibility across a vast array of devices and locations worldwide. This approach makes the Software as a Service (SaaS) model significantly more convenient compared to traditional software installations, ultimately improving the way healthcare organizations operate. Our commitment to innovation positions us to meet the evolving needs of the healthcare industry.

Claims processing can stretch over several months, making it increasingly challenging to control associated costs by that time. A mere few minutes of delay in recognizing patient activity can lead to an unwarranted and expensive hospital admission, which is crucial in the realms of care coordination and achieving success in value-based contracts. MemberMatch delivers these critical insights instantly, equipping care teams with timely intelligence that enables them to proactively and efficiently address active care episodes. This approach assists risk-bearing organizations in enhancing both the quality of care and the financial implications of member interactions throughout the care continuum, ultimately resulting in improved patient outcomes and a healthier financial situation for the organizations accountable for their well-being. By facilitating connections between your care team and the clinical staff involved, essential context can be provided to improve the quality and cost-effectiveness of encounters, helping to prevent unnecessary admissions to out-of-network facilities and redundant testing. In essence, this real-time data empowers healthcare providers to make informed decisions that can significantly benefit both patients and their organizations.

An all-encompassing and adaptable toolkit that empowers healthcare professionals to evaluate, review, document, and monitor patient conditions is essential for effective patient care. The HCS Assessments Design Kit offers users the ability to develop or modify clinician-level documentation in accordance with current or anticipated workflows. For facilities that still rely on paper records or alternative electronic health records, this kit provides the adaptability needed to replicate existing documentation while ensuring data is captured accurately and discretely. Users can choose from a comprehensive library of pre-existing assessments, create custom assessments, or utilize a combination of both methods. These assessments can be employed either as a singular documentation event or for continuous documentation, with options that allow facilities to determine whether data entry is mandatory or optional. Various methods for data entry, including text inputs, drop-down selections, radio buttons, and multi-select options, facilitate straightforward customization and enhance workflow efficiency. Additionally, a brief overview of the available templates is presented below.

FIT eLearning offers a modern and accelerated approach to mastering and applying feedback-informed treatment, rooted in the innovative PCOMS evidence-based methodology. This program is tailored to enhance your skills and confidence, catering to various learning preferences, while ensuring a comprehensive grasp of both PCOMS and FIT. It facilitates a meaningful evaluation process for clients, enabling effective tracking of session ratings through a straightforward red, yellow, and green signaling system. Additionally, participants can assess their clinical effectiveness across diverse clients, establish their professional baseline, and monitor gradual improvements in their skills over time. Upon completion, learners receive a certificate recognizing 12 hours of online psychotherapy training focused on feedback-informed treatment. Whether you are an independent practitioner or part of a larger healthcare organization, FIT eLearning fosters a strong culture of feedback and seamlessly integrates outcome and session rating scales (ORS & SRS) into your therapeutic practice, ultimately enhancing client care and engagement. By embracing this innovative training, you will be equipped with the tools necessary to create a more responsive and effective therapeutic environment.

The budgeting process in hospitals is fundamentally flawed and inefficient. Typically, these organizations invest anywhere from three to six months and over 100,000 hours to create a budget that often misses the mark by tens of millions of dollars and becomes outdated as soon as it is completed. There must be a more effective solution, and such a solution exists. StrataJazz stands out as the most comprehensive Advanced Planning tool available, fundamentally transforming the way healthcare providers approach planning, budgeting, forecasting, and managing both operating and capital expenses. As a result, the planning process becomes not only more efficient but also more accurate and responsive to change. By implementing top-down rolling planning methods, integrating relevant cost data seamlessly, and utilizing advanced automation, workflow, and analytical best practices, StrataJazz fosters a collaborative and results-driven budgeting process that is markedly more precise and considerably less time-consuming. This innovative approach ultimately empowers healthcare organizations to allocate resources more effectively and enhance their financial performance.

Empower strategic decision-making and foster enhanced collaboration among diverse functions within the healthcare ecosystem. The Incedo™ Healthcare Management Platform presents a robust solution for medical management, seamlessly fusing care management, utilization management, care coordination, and healthcare navigation efforts to boost operational effectiveness and improve patient outcomes. It strengthens communication and teamwork among Care Management, Clinical, and Utilization Management teams by providing a unified view of the member care plan, ensuring a smooth transition between Utilization Management and Care Management. The platform's advanced data capabilities streamline data collection and ensure compliance with CMS regulations through a versatile data repository that can be tailored for detailed data tracking and reporting. Additionally, it promotes system interoperability, enhancing the overall integration within healthcare systems. By implementing this innovative platform, organizations can significantly upgrade their operational processes and patient care quality.

Discover an analytics-focused solution for managing claims and remittances designed specifically for healthcare providers aiming to streamline workflows, optimize resource use, reduce denial rates, and enhance cash flow. Boost your initial claim acceptance ratio with our extensive editing package that keeps you updated on the latest payer guidelines and regulations. Elevate your team's efficiency by utilizing user-friendly workflows that prioritize exceptions and automate routine tasks. Your team can conveniently access our versatile, cloud-based platform from any computer to ensure seamless operations. Effortlessly handle your secondary claims volume with the automatic creation of secondary claims and explanations of benefits (EOB) based on primary remittance advice. Leverage predictive artificial intelligence to concentrate on claims that require immediate attention, allowing for quicker error resolution and minimizing the risk of denials prior to submission. Achieve greater efficiency in your claims processing, whether you’re printing and dispatching primary paper claims or including organized claims and EOBs for secondary submissions. By implementing these advanced features, you can significantly enhance your overall claims management strategy.

Since its inception in 1992, Orion has been dedicated to delivering innovative technological solutions and professional services aimed at enhancing the workflow within the fields of addictions and mental health. The flagship product, AccuCare EHR, is a cloud-based software developed by a skilled team of clinicians and engineers, designed to optimize key aspects of an agency's operations, covering clinical, financial, billing, administrative, and research functions. AccuCare offers a comprehensive suite of features, including tailored screening and assessments, admission and discharge processes, treatment planning, progress notes, telehealth capabilities, e-prescribing, scheduling, electronic billing, and customizable reporting, among others. Additionally, the AccuCare Web-Based Practice Management System comes with the support of a committed team of specialists who are readily available to address any inquiries regarding system functionality and integration with existing documentation and billing workflows. As part of your subscription, you receive dedicated customer support along with automatic updates and enhancements driven by genuine user feedback, ensuring your system remains relevant and effective in meeting your needs. This commitment to continuous improvement reflects Orion's mission to empower professionals in the addiction and mental health sectors.

Inventory management holds critical significance across various sectors, but it is particularly vital in the medical device sector, where individual products can carry a price tag of thousands of dollars and surgical loaner kits can reach tens of thousands. By efficiently tracking, managing, and utilizing field inventory, medical device manufacturers and healthcare facilities can enhance their sales revenue, minimize inventory capital outlay, and reduce operational costs. Medical Tracking Solutions, Inc. (MTS) was founded by a skilled group of industry experts specializing in medical device sales, distribution, logistics, loaner kit processing, and software development. Currently, both manufacturers and hospitals can utilize MTS's proprietary software, iTraycer, independently, or they can opt for a comprehensive service where MTS collaborates with logistics companies to provide a complete solution for case scheduling and the management of medical device field inventory. This dual approach allows for flexibility and efficiency, catering to the diverse needs of the medical device industry.

To successfully oversee patient care, a strategic blend of clinical expertise and software solutions is essential. In an industry often characterized by its heavy reliance on human labor, these resources must not only support and enhance the management of care but also play a significant role in boosting organizational profitability. AveCare offers an integrated approach to care management that encompasses functions like Care Management (CM), Disease Management (DM), and Utilization Management (UM), all while providing streamlined workload management and competitive pricing. This innovative solution enables healthcare organizations to maximize their clinical and financial resources, ultimately leading to improved quality of care and better patient outcomes. By facilitating the exchange of data from various sources such as eligibility, claims, pharmacy details, diagnostic and lab results, as well as predictive modeling and decision support tools, AveCare ensures comprehensive patient information is readily available. Designed for integration, it allows for efficient coordination of case management, disease management, and utilization management processes, ensuring that organizations can easily access all relevant CM, DM, and UM activities from a single point. This holistic approach not only enhances operational efficiency but also leads to a more cohesive strategy in patient care delivery.

VitalHub offers a comprehensive range of solutions aimed at enhancing Patient Flow, Operational Visibility, and Patient Journey Optimization, specifically tailored for intricate hospital and integrated health systems. Our innovative technologies enable frontline staff, healthcare providers, and management to elevate patient experiences while maximizing operational efficiency, which ultimately leads to safer healthcare delivery. We provide advanced solutions that focus on refining patient flow, perioperative services, demand and capacity management, virtual consultations, clinic oversight, and the overall patient journey. Additionally, VitalHub fosters improved transparency and communication through real-time visibility across the entire system, facilitating integrated information exchange for coordinated care, and optimizing patient movement throughout the facility. Our suite of EHR solutions transcends typical clinical data collection by offering a detailed and holistic perspective of patients and clients right at the point of care, ensuring that healthcare providers can make informed decisions swiftly and effectively. This commitment to comprehensive care and operational excellence positions VitalHub as a leader in transforming healthcare delivery.

Personify Health stands as a pioneering personalized health platform, delivering integrated solutions that encompass health, wellness, and navigation services. Established from the merger of Virgin Pulse and HealthComp in November 2023, the company seeks to streamline the healthcare experience by offering personalized, interconnected, and user-centric services. Their all-encompassing platform features various offerings, including health plan management, comprehensive wellbeing initiatives, and care navigation assistance, all crafted to encourage individuals to take a more active role in their health journey. Through the use of data-driven personalization and scientifically-supported strategies, Personify Health not only aids businesses in maximizing their healthcare investments but also enhances health outcomes for their members. By focusing on individual needs and preferences, Personify Health is setting a new standard in the healthcare industry.

The Care Management Suite represents a comprehensive, data-informed solution for managing care, featuring a suite of tools and processes designed to enhance visibility across the entire spectrum of high-risk and at-risk patient populations. By enabling more efficient and patient-focused workflows, the suite aims to elevate the quality of care delivered while simultaneously lowering overall healthcare costs. Through the use of data analytics, the Care Management Suite identifies areas for improvement throughout the care process, thus driving better clinical, operational, and financial results. This solution is comprised of three key applications: Population Builder™: Stratification Module, Population Care Workflow, and Population Care Insights, each playing a vital role in the care management process. The suite offers a cohesive, end-to-end workflow that encompasses everything from patient enrollment and ongoing care management to patient record-keeping and collaboration among care team members, ultimately saving time and enhancing the standard of care delivered. Additionally, its analytics-driven Data Operating System platform consolidates various claims and electronic medical record data, creating a holistic view of each patient. By leveraging these insights, healthcare providers can make more informed decisions aimed at improving patient outcomes.

The process we follow for setup is straightforward and efficient. We take the initiative to incorporate our HIPAA-compliant software and services seamlessly into your current workflow. This software is designed to analyze your patient population, pinpointing individuals who might be eligible for Chronic Care Management (CCM) and various preventive programs. Our combination of a dedicated care team and advanced software can handle tasks like enrollment and eligibility verification, patient outreach cycles, and meticulous record management, among other functions. With our integrated approach, we stay closely attuned to the needs of your patients, ensuring timely responses. Our user-friendly, one-click interface provides physicians with essential information about patients requiring urgent care. This is how our system operates:

Numerous patients are in urgent need of your home health services, yet many doctors who could refer them are not doing so. This situation is likely a result of your sales and marketing teams not accessing the 75% of Medicare claims that correspond to office visits. It is essential to showcase your capability to reduce expenses while enhancing patient outcomes. For instance, Home Health Agency A can swiftly illustrate its superior performance over Home Health Agency B concerning hospitalization and readmission statistics. Marketscape for Home Health empowers you to transform your sales and marketing approach, ensuring that you target the most promising physician and facility referral sources. Our innovative technology and dedicated support enable you to efficiently assess your standing against competitors based on various metrics, including hospitalization and readmission rates, diagnostic categories, acuity levels, time to initiate care, overall care costs, and numerous other quality indicators. By leveraging this information, you can strategically align your efforts to maximize referrals and ultimately improve patient care.

Our state-of-the-art technology, powered by artificial intelligence (AI), transforms both organized and disorganized healthcare information into a dependable, high-quality, standardized dataset that can be utilized throughout your organization. By facilitating near real-time access to data from various systems, our solutions alleviate the strain of manual data abstraction, enabling your administrative and clinical teams to reclaim valuable time for quality improvement and research endeavors. Our suite of products and services empowers you to gather, assess, and utilize your data effectively, irrespective of the data source, therapeutic area, organizational department, or pre-existing reporting, business intelligence, or analytics tools. Atlas leverages both human knowledge and AI capabilities to streamline the challenging process of uncovering and interpreting patient data for clinical registries. Meanwhile, Cartographer efficiently searches, evaluates, and interprets patient data across multiple platforms, standardizes that information into a uniform format, and offers pertinent data insights. Ultimately, our innovative solutions not only enhance operational efficiency but also support informed decision-making throughout your organization.

CareStat represents SHP's all-encompassing analytics solution for post-acute care, effectively connecting acute care providers, ACOs, payers, and physician groups with skilled nursing facilities and home health agencies. Our mission is to collaboratively enhance the management of patient outcomes, operational efficiency, utilization, and partnerships between post-acute providers. Utilizing SHP's exclusive readmission algorithms, CareStat integrates real-time OASIS and MDS data to facilitate patient management throughout the entire care continuum. This implementation not only aims to minimize readmissions and shorten hospital stays but also to foster better collaboration and improve referral practices, ultimately leading to heightened patient satisfaction. By streamlining the data transfer process for quality and outcome metrics, we help organizations save valuable time. In a metrics-driven landscape, your organization understands the necessity of actionable insights, and achieving your goals demands the right tools and expertise to function optimally. Overall, CareStat is designed to empower providers with the insights they need to drive better patient care outcomes.

CaseTrakker offers a holistic care management solution that guarantees your team has access to the latest information and essential tools for effective member management. Their all-encompassing care management software features a wide array of tools addressing every aspect of health management, including care management and utilization review, among others. With these products, organizations can optimize their core business processes and enhance productivity while maintaining high-quality care management results. Additionally, CaseTrakker portals deliver customized, secure, browser-based access to all CaseTrakker data. These portals create a personalized experience, fostering collaboration among members, providers, clients, and care management teams, accessible from any device, ensuring seamless communication and coordination. This integration of technology not only improves efficiency but also strengthens the overall care management framework.

Acuity Advanced Care™ is a versatile on-premise population health platform tailored to meet the varied requirements of case, utilization, disease, and population health management initiatives. This system empowers organizations by granting them total control over their environments, allowing for customization to fit each organization's distinctive care model. Notably, over 90% of clients utilizing Acuity Advanced have achieved NCQA or URAC accreditation, or both. The platform combines the advantages of on-premise flexibility with comprehensive database access, ensuring that organizations maintain control over data storage. Ideal for customers with skilled IT teams, Acuity Advanced Care allows for effective setup, security, and management of intricate systems. Chordline Health stands out as a premier software provider catering to health plans, TPAs, ACOs, and other organizations that assume financial risk. The Chordline team, composed of US-based clinicians and developers, is celebrated for their exceptional managed care expertise and commitment to customer service, further enhancing the overall experience for users. This dedication to quality ensures that clients receive the support they need to thrive in an evolving healthcare landscape.