Triad HealthCare Network Partners with TCS Healthcare Technologies to Implement Utilization Management System in Only 60 Days
The ACO’s utilization management department was approving care for HealthTeam Advantage (HTA) members without missing a beat.

 

GreensboroNo one wants to switch utilization management systems. That was especially true for Greensboro-based Triad HealthCare Network (THN). The accountable care organization (ACO) uses a sophisticated utilization management system to approve tests, hospital admissions and other care for customers of Cone Health’s Medicare Advantage plan, HealthTeam Advantage. But after Cone Health bought out its partner in the insurance plan, HealthTeam Advantage would no longer have access to a system.

“We quickly realized we didn’t want someone to run a utilization management system for us. We wanted to bring the process in-house,” says Elissa Langley, chief operating officer, Triad HealthCare Network. “THN has a lot of specific needs around population health and ideas for the future. Our system needed to be robust but very flexible.”

So THN decided on ACUITY Advanced Care, a care management software system from TCS Healthcare Technologies. It supports utilization, case, and population health management programs. That was important for THN because HealthTeam Advantage has a reputation for superior service for patients and providers.

Switching to a new utilization management system requires a team with excellent technical skill and clinical expertise, especially when facing a tight deadline. “Both teams at THN and TCS Healthcare have been outstanding,” Langley added.  “TCS not only demonstrated technical expertise during the implementation, but also brought significant managed care experience to the effort.”

THN is now able to give HealthTeam Advantage providers real-time approvals for requests, quick turnaround compliance, and reporting. “This is important to meet our continuous quality improvement goals and keeping our 14,200 covered lives returning as customers,” says Langley.

“TCS is excited to partner with Triad HealthCare Network, a highly recognized Next Generation ACO,” says Deborah Keller, BSN, RN, CMCN, and chief operating officer for TCS. “An implementation including utilization management workflows done in less than 60 days is unmatched in the care management software industry. This success speaks to the dedication and skill level of both teams.”

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Triad HealthCare Network (THN) is a provider-led, accountable care organization (ACO) composed of community physicians, Cone Health and its physicians and hospitals, and other providers who together provide higher quality, better-coordinated and more efficient care for patients. THN improves the quality and value of health care in the Piedmont Triad by focusing on preventive care, improving communication and data flow among providers, and by providing innovative services. THN is a subsidiary of Cone Health and is governed and operated by a board of managers and a physician-led operating committee.

TCS Healthcare Technologies (TCS), based out of Sacramento, CA., is a leading provider of software and clinical solutions that support and improve medical management operations for health plans, specialty plans, TPAs and risk-bearing provider groups. TCS’ team of US-based clinicians and developers are recognized for their best-in-class managed care expertise and customer support throughout the industry.