MCO Oversight

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HID offers a high-quality, transparent solution for evaluating the accessibility to medications and the quality of drug use management programs of Medicaid Managed Care Organizations (MCO). Our utilization review services and oversight processes “promote the delivery of quality care in a cost effective and programmatically responsible manner” for the fee-for-service population in response to the CMS Medicaid and CHIP Managed Care Final Rule. Let our data analysis platform and clinical expertise paint a broader picture of population health and coordinated care within your state.

Features

Gain access to time-tested, industry proven best practices that help remove barriers to understanding the impact of managed care in your state. Our clinical experts and workflow and process designers know how to create successful coordination and oversight of drug use management processes in state Medicaid MCO pharmacy programs. We ensure compliance with pertinent standards and regulations regarding quality of care and clinical efficacy.

Oversight Management

HID provides ongoing review of MCO drug use management programs to determine formulary changes, prior authorization requirements, and utilization management practices.

Integrated Processes

Our program has developed an assessment, review, and evaluation process to ensure that MCOs provide comprehensive clinically based and accessible pharmacy services to Medicaid recipients.

Best Practices

We've combined HID’s DUR program, board support, and P&T committee duties into a proven workflow process, creating a single entity for transparent oversight and open communication.

Streamlined Reporting

Dashboard reporting provides clients with a clear view of comprehensive population utilization and sub-population cost trends.

Benefits of our expertise

HID has considerable experience performing MCO oversight activities in support of state drug utilization management programs, which have been acknowledged as best practices by CMS.

What you get:

  • Oversight of various programs within population including criteria management and data analysis and increasing number of new and specialty drugs
  • Increase level of communication and engagement with state MCOs
  • Comprehensive, detailed annual surveys sent to MCOs for deeper understanding of MCO policies and procedures, criteria, and statistical information
  • Collect data and evaluate trends for the entire Medicaid program
  • Mitigate risks in Medicaid cost-containment efforts