ConcertoHealth Awarded NCQA Accreditation for Utilization Management

 

ALISO VIEJO...September 9, 2019 -- ConcertoHealth®, the leading full-risk provider of field-based complex care and supporting clinical services for vulnerable, frail and elderly patients, announced today that it has been awarded Accreditation in Utilization Management by the National Committee for Quality Assurance (NCQA). This gold-standard, independent accreditation favorably positions ConcertoHealth to accept utilization management delegation for future health partners.

The utilization management approach by ConcertoHealth acts as an early warning system to alert care teams of possible sentinel patient admissions and requests. This process ensures patients receive the right care, at the right time, at the right place from the correct care team member by providing direct referral to the care team. For example, patients lacking medical history who present with a new condition or disease are referred immediately to the clinical team for timely interventions that empower patients and prevent future readmissions. Additionally, ConcertoHealth provides all care team members access to Patient3D, a proprietary health data analytics platform. Patient3D offers providers a panel view that includes a patient's real-time admission and discharge activity, medications, longitudinal medical history and care management notes as part of the workflow.

"We're thrilled that ConcertoHealth has received a three-year Accreditation for Utilization Management," said Dr. Jeffrey Hunter, ConcertoHealth Senior Vice President, Utilization Management and Quality Improvement. "This honor validates our role as a clinical collaborator in managing a fragile, vulnerable population that typically is bounced from setting to setting. We can determine medical necessity in near real-time for patients who have needs that exceed traditional measures and engage our field-based care team to intervene in a timely manner."

ConcertoHealth field-based care teams provide support services for health plans' primary care providers (PCPs) to address the clinical and social determinants that act as barriers to preventive care for underserved populations. ConcertoHealth brings to PCPs a full-service array of clinical talent, including social workers, care managers, pharmacists, health coaches and complex care clinicians, to care for patients in any setting. Combined with Patient3D, ConcertoHealth helps PCPs to more effectively manage these at-risk populations in a value-based environment.

"Achieving NCQA Utilization Management Accreditation demonstrates that ConcertoHealth has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards," said Margaret E. O'Kane, President of NCQA.

About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA's website (ncqa.org) contains information to help consumers, employers and others make more informed health care choices. NCQA can be found online at ncqa.org.

*NCQA has reviewed and accredited ConcertoHealth's utilization management functions only.

About ConcertoHealth®
ConcertoHealth Inc. is the leading provider of specialized field-based complex care and supporting clinical services for vulnerable, frail and elderly patients. ConcertoHealth provides high-touch, individualized care for patients, and also deploys wraparound clinical resources to extend the reach of primary care providers. Operating exclusively in value-based agreements, the ConcertoHealth care model, elevated by Patient3D, improves overall health quality and outcomes for high-need patient populations. The ConcertoHealth care model is proven to reduce admissions by 30.3% and readmissions by 17.1%, benefiting patients, payers and their provider networks alike. The company is headquartered in Aliso Viejo, California and can be found online at www.concertohealth.com,

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