Proactive Solutions

Mid Atlantic Health Solutions offers proactive Utilization Management by evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the health benefit plan. Our services are conducted telephonically, at the national level, and under the supervision of our Medical Director while utilizing evidence-based, nationally recognized criteria. Monitoring for the appropriate care of level and identifying cases at risk for readmission increases quality of care and reduces unnecessary costs for members and their health plans.

Our Diabetes Management Program supports and encourages members with diabetes to better manage their condition and reduce the risk of complications associated with diabetes through optimal self-management.  Proper control of diabetes goes beyond prescribed pills and injections. Our nurse case managers interact with members telephonically to address diabetes self-management, paying critical and ongoing attention to weight, diet, glucose levels, blood pressure and other clinical metrics that lead to successful solutions.  These solutions favorably impact health outcomes and healthcare cost control for the member and the health plan.

Realizing that premature and low birth weight babies can be very costly, our Maternity Management Program offers assessments, education, and support from pregnancy to delivery for health plan members.   Collaboratively, our experienced case managers work with expectant mothers and their healthcare providers to reduce the incidence of premature births and low birth weight babies.  Identification and monitoring of at-risk mothers is key to maximizing healthy pregnancies and deliveries while minimizing costs. When a pregnant woman reaches the optimum level of prenatal health, everyone benefits- the mom, the baby, the family, and the health plan.

Our Case Management supports the most costly segment of members- those experiencing immediate and ongoing medical conditions or injuries that may require complex, high intensity, long-term and/or high utilization of services.  Here at Mid-Atlantic Health Solutions, our telephonic Case Managers assess member engagement in the treatment process and identify those at-risk in order to improve healthcare outcomes.  When statistics support that 20% of  health plan members can account for 80% of healthcare dollars spent, health plans need solid solutions to address this population.

Simple Solutions, our physician credentialing service, assists individual physicians as well as larger group practices in navigating the credentialing process required by health plans, provider networks, and hospitals for participation.