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Know your members.
Improve their health.

Learn more about what’s right for you.

Payment Accuracy

Coordination of Benefits Coordination of Benefits
Payment Integrity Payment Integrity
Population Health Management Population Health Management
Advisory Services Advisory Services

One of the best ways to improve the efficiency of our healthcare system is to have fewer sick people.

We have a solution that accomplishes this goal right now, and it’s making larger impacts every day.

Our whole-person Population Health Management solutions improve the well-being of your population by identifying high- and rising-risk members, providing comprehensive care management when needed.

These tactics create a measurable increase in the overall health of a population, helping plans meet the triple aim of a better member experience, improved health and outcomes and lower costs.

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We help you turn insight into action.

Your members can be:

  • Healthy, or those whose health status is currently unknown
  • Hidden risk, those who are more likely to develop a serious condition
  • High utilizers who, for example, overuse the ER
  • Critical, those who currently have an acute or chronic illness

Our risk intelligence solution uses advanced predictive analytics to identify and stratify your existing members. With our solution, you can identify risk as early as the point of enrollment and continuously monitor members on a monthly basis, proactively identifying rising risks related to medical conditions, patterns in utilization, social determinants, controlled substance utilization and other factors.

Those in a high-risk category will be passed to our care management module, Essette, to be engaged directly by a care manager.

When a member develops or is heading towards a chronic condition, HMS’ Essette is there to facilitate one-on-one interactions with a sensitive and compassionate care specialist.

Our care management platform enables better coordination of care delivery and enables health plans to meet National Committee for Quality Assurance (NCQA) requirements.

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

Five adaptable products are intuitively designed to streamline your care management activities:

  • Case management
  • Utilization management
  • Population management
  • Appeals and grievances
  • Customer service

Our platform also offers advanced capabilities to expedite and enhance care delivery. These modules include:

  • Provider portal
  • Fax management
  • Business intelligence (analytics)

All modules can be incorporated at launch or added as needed. We’re easy.

We specialize in seamless integrations that streamline your care management ecosystem.