What We Do
Welcome to Health Service Review. We are people serving people in the delivery of healthcare for employers who self fund their benefit plans.
Mission
HSR's mission is to maximize the quality of life for employees while saving substantial healthcare costs and productivity loss associated with sick employees. In other words, enable the building of healthy businesses through healthy people.
Services
HSR establishes long-term relationships with our clients. Why the loyalty? HSR provides client-centered solutions that meet their needs. Employees feel like someone really cares (because HSR does) and employers love the way HSR "flattens" the healthcare cost curve.
We've been doing this since 1983 and clients love it. Since HSR is able to detect and manage possibly catastrophic losses at the earliest possible date, we are able to avoid a lot of needless costs. HSR is able to reduce costs because 80% of healthcare cost is the result of claims.
TPA Services
HSR combines a high-tech claims adjudication system with a highly tenured staff that averages 25 years of claims experience. What does this mean for the client? Our operations and management staff gives HSR clients flexibility and the option of maintaining the type of healthcare plans that best suit their needs.
HSR offers the following TPA Services:
- Medical, Dental and Vision claims payment
- Health Savings Account (HSA) Administration
- Health Reimbursement Arrangement (HRA) Administration
- Short Term Disability Administration
- Flexible Spending Account (FSA) Administration
- EDI
- COBRA/HIPAA Administration
Healthcare Management
The biggest impact on healthcare cost is through educating patients so they become active participants in their own healthcare. HSR's nurses are all RNs and we've been patient care advocates since 1983. This focus enables us to provide a personal touch to care management, while saving clients considerable healthcare dollars.
HSR's Healthcare Management consists of the following services:
- Utilization Review
- Case Management
- Disease Education/Health Coaching
- Predictive Modeling
Utilization Review
HSR's nurse reviewers ensure that safe, appropriate, effective treatment is provided. HSR's nurse reviewers also verify that treatment meets medical necessity criteria for the patient's specific condition. In determining the optimal medical environment, our RNs carefully balance inpatient stays versus outpatient alternatives.
Case Management
HSR Case Management returns $30.00 for every dollar invested! A centerpiece in the Managed Care Program, Medical Case Management focuses on cases which involve high-cost diseases, conditions or procedures.
The goal of Medical Case Management is to move patients from acute- care hospitals to more normal, cost effective environments (often the home) as soon as it is medically feasible to do so. Medical Case Management identifies potential cost savings by screening admissions that fall into specific injury, illness or cost profiles.
HSR staff physicians and case managers work with the attending physician to develop an effective plan tailored to the patient's individual needs. Early intervention helps shorten treatment periods in acute care facilities in favor of equally appropriate, but more cost effective rehabilitation services or sub acute care. HSR goes a step further and conducts periodic follow-up to ascertain the continuing effectiveness of the approved plan. This ensures that the client's healthcare dollars continue to be spent wisely.
Disease Education/Health Coaching
HSR's Disease Education is a comprehensive, integrated approach to addressing a chronic condition, rather than acute episodes. This results in improved quality of life at a lower cost.
Understanding and acceptance is the key to successfully living with such chronic diseases as:
- Diabetes
- Asthma
- Cardiovascular Disease
- COPD
- CHF
- CVA (Stroke)
- Osteoporosis
- Migraine
- Multiple Sclerosis
HSR's Disease Education Program focuses on helping the patient become a knowledgeable consumer. For example, diet, weight loss and exercise are all very important in controlling diabetes. Our Disease Education Program teaches an employee to live a healthy lifestyle to prevent diabetic complications such as heart disease, blindness or kidney damage.
The result is patient empowerment that increases productivity by reducing hospital stays, unplanned healthcare services and absence from work.
Specialized disease case managers coordinate care, working aggressively to assure:
- Early intervention
- Appropriate, holistic treatment
- Treatment plan compliance
- An understanding of all risk factors
- Patient acceptance of disease self-management
- Patient responsibility for lifestyle changes
Predictive Modeling
HSR utilizes medical artificial intelligence predictive modeling software to analyze the disease profile of plan members, identify chronic diseases within the group, and ascertain potential case management clients.
Additional benefits offered by predictive modeling and the Disease Education process include the following:
- Precise identification of case management patients within the plan
- Identify cost drivers for high risk population
- Forecasting of future health plan costs
- Ability to evaluate patient health patterns over time
- Improve outcomes
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HSR's predictive modeling uses NCQA standards |
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HSR's Case Managers are certified through The Commission on Case Manager Certification |
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All HSR's medical management staff are RNs |
