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Physician-Led Medical Management
With the goal of providing quality healthcare and a better patient experience, MHealth facilitates a new level of communication between healthcare professionals, assuring the most appropriate care in every patient setting. This results in better outcomes and lower re-admission rates.
By tracking hundreds of thousands of outcomes, the MHealth medical management team is able to employ evidence-base protocol. Authorizations for hospital admissions, surgeries and many types of testing are applied to standard criteria for medical necessity and length-of-stay. Any requests not meeting the criteria for medical necessity are referred to one of the MHealth physician medical directors. There are additional physician medical directors at Memorial Hermann hospitals who interact directly with members and member physicians to determine appropriate treatment plans and eliminate redundant testing and unnecessary procedures.
On any question of medical necessity, a physician medical director–never a case manager or a nurse– will contact the consulting physician to discuss treatment options and determine the best and most cost-effective treatment plan. This physician-to-physician communication allows for flexibility when needed, while safeguarding against unnecessary costs.
A staff of case managers and nurses works closely with physician medical directors to track patient progress and to monitor hospital admissions, keeping hospital bed days at a minimum. All MHealth physician medical directors are board-certified in various specialties, including occupational medicine. As needed, the medical directors may request the assistance of specialists in the MHealth Provider Network, more than 3,400 physicians practicing in Houston and the surrounding 11-country area.
Claims Processing Services
With MHealth, you can be confident that all claims will be processed swiftly and accurately. Our fully integrated claims management program links our claims payment, case management and pre-certification systems with the Memorial Hermann Healthcare System case management program to ensure streamlined negotiations and decreased turnaround for claims payment. MHealth’s aggressive approach to claims administration and medical care management has achieved significant savings for our clients.
MHealth Provider Network
Through its association with the Memorial Hermann Healthcare System, MHealth has developed one of the most comprehensive provider networks available. Through our own network development initiatives and in partnership with nationally recognized organizations, we offer access to high quality providers in virtually any location. We can also customize provider networks to meet your needs, whether you desire an EPO or PPO.
Pharmacy Network Administration
MHealth partners with several pharmacy benefit management companies to provide pharmacy access to more than 62,000 pharmacies across the United States, including all the major retail chains. We can tailor your prescription drug program based on your employee demographics, utilization thresholds, and your healthcare trends and we offer several programs to aid in controlling costly prescription benefits including mandatory generic usage, prior authorizations and quantity limitations, age limitations, drug-to-drug interaction alerts, refill limitations, and duplicate drug class alerts. We also offer specialty drug programs to help manage high-cost therapeutic agents such as injectibles.
Stop Loss Insurance
MHealth has partnered with leading A.M. Best-rated companies to provide you with the most competitive stop loss quotes available. Whatever your industry, you’ll be fully protected by one of the following providers.
A.I.G. Life (A+)
American Fidelity (A+)
American National Life of Texas (A)
Companion Life Ins. Co. (A)
Employer Reinsurance Corporation (A+)
Gerber Life Ins. Co. (A)
Lloyd’s of London
The Hartford (A+)
Highmark Life Ins. Co. (A-)
QBE Reinsurance Corp. (A)
Sirius America Ins. Co. (A)
Standard Security Life of New York (A)
United Healthcare Insurance Company (A+)
Sun Life of Canada (A+)
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