Connect & Care Audit and Consulting

Available Auditing and Consultancy Services

General Health Plan Assessment

Our General Health Plan Assessment provides an end-to-end review of your existing health plan. We review all the information provided to you by your existing vendors / partners. We furnish a reassessment of information and verification of claims data. This “second opinion” will provide you with a comprehensive appraisal and a blueprint to better outcomes for your health plan.

Clinical Reports and Analysis

Analysis & reporting without intervention provides NO value!

Most employers are under the impression that their backs are against the wall when trying to reduce healthcare spending
The majority of analytic platforms provide you with a report that tells you what you already know.
They may provide a breakdown of where you are spending your healthcare dollars - heart care, cancer care, or missed preventive health opportunities, as well as other expenditures

But these analytic platforms can’t actually do anything about the information they give you.

What you need is a company that can analyze your data AND do something about your healthcare spend problems including high costs, gaps in care, high-priced medications, overutilization, etc.

Care Gap Assessment

Without Connect & Care, you have care gaps in your health plan

You likely have multiple vendors that each may be servicing one or several components of your plan
But they are, most likely, not integrated OR they are not working synergistically

If your existing vendors / partners are not engaging every member of your plan with a customized, tailored care program, then YOU HAVE CARE GAPS!

Case Management Program Review

Case management programs are vital components of any health plan that ensure employees or members are receiving at least the minimum care required for their condition.

However, most Case Management / Care Management programs are limited in their scope as they only the address a few disease conditions (usually the 4 or 6 most common, including diabetes and COPD)

Most Case Management / Care Management programs fail because they miss other disease conditions, AND more importantly, fail to recognize “pre-clinical” conditions.

Connect & Care can:

audit your existing Case Management program. We will determine if your existing services are providing the breadth and depth of clinical interventions appropriate to each condition and employee / member.
provide insight and recommendations on how to augment existing Case Management services

Clinical Resource Utilization

As part of our auditing and consultancy services we ensure that your employees / members are getting the right services, at the right time, and at the right price.

Medical and Pharmacy Claims Inspection

Connect & Care has its own proprietary clinical analytics platform. All analyses are performed by physician-experts. We perform a detailed review of medical and pharmacy claims to understand historical claims, present claims, and forecast trends. We identify opportunities to improve care, close clinical gaps, and reduce costs.

Wellness Program Assessment

The question you have to ask yourself is, “whether or not you are able to actually measure the Return On Investment (ROI) of your Wellness Program?”

Connect & Care can provide an unbiased assessment of your Wellness programs and either confirm or refute your existing vendor’s assertions.

If you do not have a Wellness Program, we can help outline a program taking into consideration the unique elements of your employees, industry, and workplace.

Quality Metrics

We review your existing programs to determine if they are being held to the highest quality by utilizing 200+ quality metrics supported by the National Quality Foundation (NQF), the National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), Centers for Medicare & Medicaid Services (CMS) Quality Measures, and clinical care guidelines established by professional clinical organizations.

Population Health Program

There are intrinsic problems with Population Health Programs.
Because the definition of Population Health is poorly defined, programs suggesting Population Health benefit remain largely elusive, and therefore problematic.

Connect & Care can tell you if your existing services and vendors are providing you with a Population Health program.
Connect & Care’s physicians and epidemiologists will assess your existing program. If you don’t have one, or think you do have one and we show you that you do not, we will recommend a Population Health program.

We will show you a Population Health program that is uniquely suited to your “population”, employs responsible clinical management, assigns accountability, and results in improved clinical outcomes at a reduced cost.

Our Results

On average, we detect more than 100 unique items in existing healthcare programs that fail to meet acceptable standards of medical care and / or missed opportunities in patient management.

Connect & Care’s Auditing and Consultancy has demonstrated savings approaching 20% on medical and pharmacy claims, while improving health outcomes.

View an illustrative Case Report

Our initial Auditing and Consultancy services are provided at NO COST to you!

Contact Connect & Care for your NO COST audit

Connect & Care, LLC
P.O. Box 25762
Columbia Station, Ohio 44028

Phone: 440-829-7562
Fax: 440-378-4018

Audit & Consultancy Services

If it involves healthcare, Connect & Care should be involved!

Connect & Care's Auditing and Consultancy will deliver honest, thoughtful answers to your questions, generated by experts, supported by facts, science and evidence-based references.