Clinical Services Optimization

ProspHire’s team of clinicians help organizations optimize processes to improve health outcomes. We have deep subject matter expertise in care management (CM), utilization management (UM), value-based care (VBC), social determinants of health (SDOH) and population health reporting. We are adept at addressing patient experience challenges, throughput optimization and clinical resource management. Our demonstrated results lead to increased profit, enhanced operational efficiency, improved clinical outcomes and a better patient and provider experience.

Download one-pager

Outcomes

ProspHire’s team of clinical practitioners advance your clinical model and level of Value-Based Care maturity with our Integrated Care Model. The Integrated Care Model brings together medical, pharmacy, behavioral and social determinants to help your organization meet the Quadruple Aim.

Data-led approach to optimize UM
UM Policy / Process Standardization
Cross continuum CM integration
Meaningful data analytics for patient identification and risk stratification
VBC Contract Analysis and Design
Contract Performance Optimization
Pharmacy and Behavioral Integration
Quality Analytics and Reporting
Network Performance Analysis

Deliverables

ProspHire meets your organization where you are on the Value-Based Care journey, and we work together to design your roadmap for future improvements that improve health outcomes.

  • Updated Medical Policies based on NCQA, state and federal requirements
  • Quality Improvement Plan
  • CM Operating Model and implementation
  • Value Stream Maps, Process Maps and Desk Level Procedures
  • Dashboards with Care and Utilization Management metrics

    Insight

    Prior Authorizations in Medicare Advantage: New Concerns and How to Address Them 

    View Insight

    Let’s have a conversation

    Deborah Holzmark is Chief Clinical Officer at ProspHire. A registered nurse with experience in the ICU, ER and PACU, Deborah brings a clinical perspective to operational engagements. At ProspHire, she is responsible for strategic planning, client delivery and the implementation of the Firm’s Clinical service offering.
    Full Bio