|
| Home
>> Work With Us >> Managed Care Organizations |
|
Managed Care Organizations - Experienced Quality Network And Support Services
What Can We Do For You?
1. Provider Network Management:
Hudson IPA offers Managed Care Organizations a comprehensive, NCQA-certified,
network of primary care physicians and specialists in Westchester,
Rockland, Putnam, Dutchess, Orange and Sullivan counties on a delegated
or non-delegated basis. Our rapidly growing network, provides the
following broad distribution:
|
| |
Dutchess |
Orange |
Putnam |
Rockland |
Sullivan |
Westchester |
Total |
| Specialists |
85 |
194 |
90 |
167 |
12 |
558 |
1106 |
| Primary Care |
25 |
99 |
32 |
101 |
13 |
252 |
522 |
| Both Specialist & PCP |
2 |
12 |
4 |
10 |
3 |
32 |
63 |
| Total |
112 |
305 |
126 |
278 |
28 |
842 |
1691 |
|
| |
|
NCQA News Release (PDF)
Hudson IPA is now NCQA Certified for Credentialing and can assume delegated credentialing and recredentialing for our members. This ensures that providers are credentialed and recredentialed on a timely basis.
2. Utilization Management: |
| Top |
 |
Using SmartCare, a cutting-edge data analytical tool, Hudson IPA's Medical Directors evaluate medical costs using data from a managed care organization's claims database. The analysis begins at the regional, hospital or specialty level and drills down to identify an individual physician's comparative and trend data. This information is used to develop interventions to modify physician behavior and address Medical Management issues that may be the cause of a high Medical Loss Ratio (MLR). |
|
|
| Some of the most common initiatives that Hudson IPA can take on, which affect the MLR, include the following: |
|
- An active role in Pharmacy formulary compliance by communicating with doctors and posting formulary information on the Hudson IPA web site.
- Perform data analysis and produce regularly scheduled reports and profiles, communicate this information to physicians and post this information on a secure, physician-only section of our web site, Hudsonipa.com.
- An active role in assisting NCQA compliance activities, including
a detailed plan relating to the collection and dissemination of
information related to HEDIS performance measures that affect
physicians. Our software has had the ability to generate HEDIS
report cards by physician since July 2003.
- Reduce Medical and Surgical Non-Par utilization through active recruitment of non-participating, high-volume specialty physicians
- Reduce Non-Par lab utilization and adherence to use of participating laboratories.
- Increase the use of outpatient facility (vs. hospital) for minor outpatient procedures.
- Reduce Emergency Room costs through active communication with member physicians.
- Reduce non-injectible Pharmacy costs.
- Participate in development of disease management programs.
- Increase the use of outpatient setting for pain management treatment.
- Educate OBGYNs to utilize High-risk pregnancy notification programs.
|
To Find Out More:
We would like to assist you in your Managed Care efforts! If you would
like to find out more about Hudson IPA's Network and Utilization Management
services, please send us a message by clicking
or call (914) 366-4472 x 202. |
| Top |
