TurningPoint Healthcare Solutions

Absolute Total Care is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective July 1, 2019. The program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Absolute Total Care members undergoing Musculoskeletal Surgical Procedures.

Program highlights include:

• Administrative Tools to support an efficient, user-friendly authorization process for procedures requiring precertification, in addition to recommended medical necessity determinations for procedures, which do not require precertification. Easy and efficient post-procedural documentation submission, which will be shared with Absolute Total Care to facilitate timely claims payment.
• Specialized “Peer-to-Peer” Engagement, where a TurningPoint physician (from the same specialty) engages the provider regarding authorization requests that require additional clinical discussion to validate the clinical appropriateness of the procedure specific to the patient’s needs and current condition.
• Clinical Support Tools to assist in the tracking and monitoring of patient outcomes and education around patient risks and preventive measures to better coordinate care for the member and reduce infection rates and complications due to patient comorbidities.
• Provider Performance Incentives for providers who comply with program requirements to practice high quality, cost-effective care.
• Reporting and Analytics that give providers and practice administrators greater visibility and transparency into their performance compared to the practice as a whole, as well as the rest of the market.
• FDA Recall Tracking and Monitoring to facilitate timely and consistent notification to the provider, patient, and to BHP when a member has received or needs a revision surgery due to a Class I or II FDA device recall.

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