By
Medical Care Review | Thursday,
February 22,
2024
Catalyst Solutions, an industry leader in strategic consulting, Business Process Outsourcing (BPO) and staff augmentation for health plans, is pleased to announce it is introducing BPO and consulting services into the clinical space of the health plan.
Catalyst’s Clinical Management outsourcing capabilities include Utilization Management, Care Management, Disease Management, and Behavioral Health. According to Scott Martin, President of Catalyst Solutions, “Depending on the needs of the payer, Catalyst has built solutions that ensure a plan’s members get the care they need without adding unnecessary costs and services that don’t bring value.”
Catalyst’s Clinical Management employees are specialized in helping members with chronic or complex conditions manage their health. Services include helping members by coordinating between hospitals and providers, and approving testing, procedures, and hospitalizations. Scott Shelton, VP of Catalyst BPO Operations, says: “Our processes are thorough and well-documented. Our people are highly trained, and this enables us to ensure that every member interaction is thoroughly documented – which is critical for establishing medical necessity and maintaining compliance with regulations and accreditation standards.”
Additionally, Catalyst’s BPO services include Machine Learning and Informatics capabilities. These innovative technologies make use of predictive analytics to forecast the needs of a health plan’s members before they escalate into costly and dangerous conditions. Martin adds: “These may be beyond the reach of some health plans and outsourcing can be the solution to help healthcare professionals get a clearer picture of the services the member is likely to require, therefore increasing the ability of those clinical professionals to provide better feedback, guidance and support.”
Health risk assessment (HRA) campaigns are another way Catalyst’s BPO can provide support. Catalyst HRAs can be used by the plan to evaluate member lifestyle factors and determine what health risks may be present. Catalyst can share this data with the plan, as well as the member’s health and wellness professionals and provide clinical insights that enable the members to make informed health decisions.
By design, Catalyst’s Clinical Consulting practice helps the clinical functions in the health plan with four separate lines of service. The first is around overcoming technology challenges by maximizing or modernizing the plan’s existing clinical platforms. The second set of consulting services focuses on optimizing business practices by improving processes and training, plus identifying tasks where automation can increase efficiency and accuracy. Thirdly, Catalyst Data Scientists and Analysts can build a robust informatics capability that delivers insights and tools for managing care, reducing costs and utilization, and driving quality of care.
Finally, Catalyst can help clinical departments create resiliency around compliance with regulatory requirements and accreditation standards – which is critical just for day-to-day services, but also when preparing for audits or post-audit remediation. According to Christine Henderson, VP of Catalyst Consulting, “Over the past 23-years Catalyst Solutions has successfully provided consulting services to health plans; however, we’re seeing a largely unmet need in the clinical space, so it is exciting to expand our support to help drive better health outcomes for members while realizing significant cost reductions for our clients.”
For more details explaining Catalyst Solutions Medical Management services, please visit: Medical Management Outsourcing – Catalyst Solutions.
