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Care Management Platform

HMS’ Essette Care Management platform provides unique and proven solutions that, combined with evidence-based content and cutting-edge technology, help you increase efficiency, meet your specific business requirements and react quickly to changing market and regulatory challenges. Our ongoing commitment to connecting fragmented IT systems and finding novel and better ways to use data continues to enhance our uniquely agile care management platform.

Our advanced, modular architecture—engineered to interface with your existing vital organizational tools including eligibility/claims systems, analytics and portals—puts personalized, data-driven and actionable care plans at your fingertips.

Proven Empowerment

75%

Reduction in task
time for clinical entries

70%

Reduction in authorization
processing time from
10 to three days

66%

Reduction in authorization
review time from 30 minutes
to 10 minutes — consolidating
five disparate systems

300%

Increase in throughput
delivering $25 million in
savings over three years

250%

Increase in throughput
by streamlining
process — reducing 12
individual tasks to three

75%

Increase in members
supported in Case
Management

Streamlined Implementations/Support

  • Implementation in as few as 60 days
  • Reduced IT and administrative costs
  • Experienced and knowledgeable 24-hour support

Flexible Workflows/ Business Rules

  • Configurable in-house with minimal IT resources
  • Easily create ad-hoc queries and reports
  • Create workflows at the population, plan and members levels

Intuitively Designed

  • Specifically for nurses and care managers
  • Easy to use — no manual required
  • User productivity on day one

Single-Member View

  • Allows input from multiple sources and variables
  • Creates a comprehensive single-member view
  • Easily integrates with all predictive analytics solutions
Core Product Offering

Our core products support all care management workflows. All products can be incorporated at launch or added as needed. Essette also allows for interoperability across multiple systems. We specialize in partner integrations to deliver seamless configurations and workflows that streamline your care management ecosystem.

Case Management [CM]

Seamlessly manage interdisciplinary care teams while performing individual member assessments and monitoring interventions.

Utilization Management [UM]

Monitor prior authorizations, inpatient stays and concurrent and retrospective reviews. Evidence-based guidelines and authorization rules inform cohorts to remain efficient while ensuring compliance.

Population Management [PM]

Manage population to identify risk levels. Organize workflows by specific criteria such as claims information or pharmacy data. Activate campaigns for the population, such as referring to case management or sending correspondence.

Appeals and Grievances [AG]

Manage member, provider, authorization denials, payment issues and other types of appeals and grievances. Guided step-by-step process using automated tasks with configurable turnaround times and attachments to stay compliant.

Customer Service [CS]

Connect customer service support with case management activities. Create new issues, provide immediate answers and efficiently route problems to the appropriate caseworker.

Supporting Modules

Business Intelligence [BI]

This reporting dashboard integrates with Essette products and provides insight into your care management domain.

Provider Portal [P2]

Streamlines tasks and notices directly to a provider, ensuring a patient receives their individualized care plan in a timely manner. Real-time authorization submission and status inquiries give the provider instant feedback.

Fax Management [FM]

Generate and automatically route authorizations, appeals or grievance cases from an inbound fax to the appropriate work queue.

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