Medical Management Consulting

Bending the Cost Curve

Accurate, integrated information lays the groundwork for a successful benefits program and strategy. If the data is flawed or incomplete, the analysis and conclusions will be as well.

We have a complete and unique clinical consulting model managed by a team of Registered Nurses. We don’t just work with the reports the insurance company provides. Our team of Registered Nurses starts with detailed member-level data, and we use this information to uncover errors, identify cost drivers and anticipate future claims. The result is actionable intelligence that empowers you to serve the best interests of your organization and your employees.

Essential components of our clinical consulting process:

Because of this unique expertise, DMA often works on a consulting basis with employers, labor unions or other benefits brokers and consultants to help identify and manage specific health care expenditures. Some examples include:

Large Case Review

Our team reviews and monitors high-cost claimants to ensure proper coding, billing and payment. We often uncover savings simply by reviewing processing errors and overpayment, and by making sure stop loss claims are submitted and paid timely and accurately.

Disease Management

Our clinical team works to identify members with chronic medical conditions and identifies ways to improve their engagement rates in disease management programs. We identify members for outreach and work with the vendor so that your programs add value and save you money.

Specialty Prescription Drug Review

Costly prescription drugs are impacting employers’ overall plan expenditures at an alarming rate. Prescription drug expenses shouldn’t be buried in cost reports; they should be reported individually, so you understand the true cost. Our clinical team identifies what medications are being used, provides expenses and cost trends and helps to assure the carrier or TPA has implemented sound prescription drug management programs and policies.