Ensure appropriate health care utilization and allocation of scarce resources while improving quality of care through Alliant’s integrated approach to utilization management (UM) and quality improvement. We use best practices in combining the best people, processes, technology, and data in a program that ensures the right care at the right time in the right setting.
Alliant offers an approach to UM derived from over four decades of experience as a UM and medical review vendor. We incorporate principles of clinical leadership, education, analytics, medical policy, and customer service into our program:
- Clinical Leadership. Our biggest differentiator is clinical leadership. We are a clinically-driven organization focused on making an impact on health care. Our clinical leaders stay current on health care trends and research to serve a medical policy consultation function for our clients in addition to directing UM.
- Education. Better educated providers provide better, more appropriate services and reduce program costs. Utilization review without education only addresses the second half of the problem.
- Analytics. Our analytical team identifies trends in program data to assist our clinical leaders in developing educational topics for your providers. In addition, our analysts identify trends that may suggest potential changes in policies or opportunities to target other providers or services for review.
- Customer Service. We incorporate the spirit of responsive, customer service and accessibility into our operations. Not only do we establish transparency and open communication with our customers, but we respond to feedback from the provider and member community.
We deploy a patient-centric, customer-focused model grounded in advanced technologies that centers on delivering quality, satisfaction and positive outcomes. Our model ensures focus on health of the member population and on customer needs. Highlights of this approach include:
- Maximizing the healthcare quality and value for customers and their members
- A focus on providing patients with clinically appropriate, evidence-based decisions
- Promoting nationally recognized best practices across the care continuum, supporting the transition to evidence-based medicine that is efficacious and cost effective
- Leadership and staff focus on understanding and meeting customer needs and expectations
- Easy access to data analytics to drive credible decision-making
- Proprietary, Web-based UM system; enhanced integration with enterprise services
The Alliant service model combines customizable, standards-based utilization management systems with promotion of clinical best practices. It does this through intensive claims review, utilization management review activities, and initiatives that target education and awareness. The model uses utilization compliance analytics for targeted UM and medical policy recommendations. Alliant’s approach improves clinical quality, promotes member and provider satisfaction, and achieves substantial savings. We help provide continuous program improvement by evaluating service outcomes, program costs and provider participation.
Our Utilization Management Program is developed, implemented, and maintained with consideration of the unique aspects of each service type. Alliant has conducted the following types of utilization management medical reviews:
- Hospital Admissions and Outpatient Procedures
- Practitioner’s Office Surgical Procedures
- Transplant Reviews
- Out-of-State Services Reviews
- Radiology—Facility and Physician Office
- Medications—Facility and Physician Office
- Physician Office Utilization
- Oral/Maxillofacial Surgery
- Emergency Ambulance Ground/Air
- Non-Emergency Travel
- Durable Medical Equipment
- Orthotics and Prosthetics
- Hearing Aide Services
- Psychiatric Outpatient Reviews
- Psychology Outpatient Reviews
- Psychiatric Admissions
- Psychiatric Residential Treatment Facility
- Community Based Behavioral Health
- Hospital Outpatient Therapies (OT, PT, ST)
- Community Based Children’s Services, including OT/PT/ST
- Children’s School Services
- Nursing Home and Community Based Long-term Care
- Private Duty Skilled Nursing Services
- Intellectual and Developmental Disabilities and Related Conditions
- Hospital Prospective Payment System Outlier Payment Review
- Health Care Acquired Conditions / Never Events