Medical Management

Preventing Health Issues from Escalating

Preventing Health Issues from Escalating through Identification, Engagement & Management of At-Risk Individuals

– Specialized in health plans with broad and deep industry experience

– Turnkey staffing, training, supervision, technology, and more

– Flexibility and agility to meet your unique needs

– Providing world class service to your customers

Catalyst Delivers High-Quality Health Management Services that are Cost-Effective and Drive Successful Patient Healthcare Outcomes

Catalyst’s goal is to help members live healthier lives– by working with health plans to improve member engagement and to assist them in making data-driven decisions.

Catalyst can:

  • Manage members with acute and chronic care needs and support lifestyle wellness initiatives – all while coordinating with doctors, health systems, and ancillary services.
  • Conduct member outreach, including health risk assessments, program enrollment, care coordination quality reviews, and gap-in-care mitigation.
  • Provide clinical claim reviews, appeals support, and prior authorization intake.

Catalyst can provide support to your plan, across the continuum of care. Our clinical outsourcing capabilities provide your health plan with a flexible, utility-based business model designed to scale as your organization grows.

Medical Management Services

– Prior authorization intake
– Clinical claims review
– Professional utilization management
– Authorization management
– Case management
– Appeals support
– Health risk assessments
– Outreach/call center services
– Program enrollment and referrals
– Patient support services
– Care coordination quality reviews
– Disease management
– Spend analytics and cost containment

Member Engagement Solutions
– Targeting specific member populations using data and analytics so the plan can deliver a relevant and timely outreach
– Improving member satisfaction by providing timely and meaningful communications
– Reducing member abrasion by streamlining communication touchpoints
– Encouraging improved health through new programs and member engagement services
– Improving industry ratings by making a positive impact on Health Effectiveness Data and Information Set (HEDIS) scores and CMS Star Rating

Comprehensive Care Management Solution
Health plans can achieve quicker implementation and greater economies of scale with our comprehensive care management solution that provides health plans with both the technology platform and the outsourcing resource for implementation. In partnership with InfoMC, our joint offering includes InfoMC’s population health SaaS platform combined with Catalyst Solution’s outsourcing and consulting services.  More details

Catalyst also provides…

BPO Services:
– Call center services
– Claims administration
– Enrollment
– Finance/billing
– Fulfillment
– Authorizations
– Grievance/appeals

Other Services:
– IT and operations consulting
– Implementation and business readiness
– MLR optimization and premium enhancement

Catalyst backs our performance with service level and financially based performance guarantees.

Contact us to begin the estimation process and learn more.