True integration meets maximum flexibility.
Improving quality of care while lowering costs sounds like an impossible dream. It isn’t. With HMS® EssetteSuite, your members will receive optimal care while your plan operates at peak efficiency.
As healthcare costs continue to climb, at-risk organizations need new ways to lower expenditures while maintaining a high quality of care. The only way this can happen is through operational efficiencies – doing more with less.
HMS EssetteSuite helps payers meet the triple aim of improving the care experience, improving member’s health, and lowering overall costs. It is a modular, flexible, user-friendly, web-based solution that gives plans a 360° view of their population. That view helps avoid unnecessary procedures, while encouraging engagement and collaboration with members and providers.
Think of our platform as your care traffic controller. HMS EssetteSuite is a multi-tenant, cloud-based architecture, designed for increased flexibility that can also be deployed on-premises if needed.
Flexibility is the key to successful implementations of the EssetteSuite. You have existing systems, and we can integrate with any or all of them to form a single cohesive platform. Our solution supports all the core functionality of care management, population management, and utilization management, and à la carte modules can be incorporated at launch or integrated as needed.
Essette Care Management
Proven tools help you improve care across the continuum, manage a comprehensive care team, and educate and engage patients.
Essette Utilization Management
Stay on top of prior authorizations, inpatient stays, concurrent and retrospective reviews. Workflow is driven by evidence-based guidelines and authorization rules to be efficient while ensuring compliance.
Essette Population Management
Stratify members of all risk levels and organize them into campaigns based upon specific criteria such as claim information or pharmacy data. Complete bulk actions for the population such as referring to Care Management or sending correspondence.
Essette Appeals and Grievances
Manage member, provider, authorization denials, payment issues, and other types of appeals and grievances with our solution. Users are guided step-by-step through the process using automated tasks with configurable turnaround times and attachments so you stay compliant.
Essette Customer Service
We have you covered you from the moment you take a call or greet a walk-in. This solution allows customer service representatives to respond more nimbly to member and provider issues all from one system without having to maintain multiple logins and passwords.
Essette Advanced Analytics delivers actionable intelligence based upon Johns Hopkins Adjusted Clinical Groups® (ACG) predictive models. Customizable dashboards and drill down metrics combined with industry-standard Healthcare Effectiveness Data and Information Set (HEDIS®) quality measurement reduce costs and improve outcomes.
EssetteSuite Business Intelligence ingests data from other Essette modules and external sources, and creates dashboards, charts, and customizable reports to help you make key business decisions with confidence.
Essette Fax Management creates authorizations, appeals, or grievance cases from an inbound fax. Faxes can be automatically routed to the appropriate work queue.
Essette Provider Portal allows a care manager to delegate tasks and notices directly to a provider, helping to ensure a patient receives the care outlined in their individualized care plan in a timely manner. The result is quicker intervention and better health outcomes. In addition, real-time authorization submission and status inquiries give the provider instant feedback.
Users love the suite’s ease-of-use, and managers love that the interface consistency across modules minimizes training time. Since the suite comes with content, you can get to work on day one. It’s also completely configurable to accommodate your existing materials and workflows.
Handy dashboards give you a bird’s-eye view of your plan, while business intelligence and advanced analytics help ensure optimal care decisions. Comprehensive reporting also allows you to breeze through National Committee for Quality Assurance (NCQA) certification.
We deliver not simply data, but actionable intelligence that improves patient outcomes. And our clinical experts can provide guidance, workflows, and integration plans so that your clinical staff can focus on their day jobs.
Contact HMS today to learn more about improving clinical outcomes, member satisfaction, and plan efficiency with EssetteSuite.