Utilization Management

Reducing Unnecessary Utilization

When over-utilization of health care services is a concern, Medicaid agencies look to eQHealth for solutions.

Our program, built on millions of patient encounters, provides the tools to better control rising medical costs. Combined with our predictive modeling, data analytics and care coordination programs, we offer all the care management tools needed to achieve better health outcomes and reduced costs.

eQHealth Solutions establishes collaborative partnerships with clients to design and implement utilization management programs. Our approach manages health care costs, better coordinates care and advances improved health outcomes for individuals enrolled in medical assistance programs.

eQHealth has extensive utilization management experience, annually reviewing more than 450,000 cases for medical necessity and appropriateness of care.

The result? We have helped our clients save up to $15 for every dollar they invest with us.

Reviews for Multiple Settings

• Inpatient medical/surgical
• Outpatient therapies
• Outpatient mental health
• Community mental health
• Home health
• Hospice
• Pediatric extended care
• Psychiatric services (inpatient and outpatient)
• Private duty nursing
• Children’s mental health services
• Home and community based services
• Durable medical equipment (DME)
• Transplants
• Emergency Care
• Family Planning

Our Utilization Teams

• Annually achieve multi-million dollar savings and strong Return on Investment for all of our Medicaid clients
• Develop and implement programs in response to state legislative initiatives
• Implement strategies to address occurrences of hospital acquired conditions
• Evaluate substance abuse service effectiveness
• Develop care management systems
• Develop systems to combat fraud and abuse

We Offer

• Experienced clinical staff
• Web-based interfaces with providers and payers
• Smart Reviews – Clinical algorithms that automatically drive quality and utilization management processes
• Sophisticated call center operations