SERVICES


At Primary Health Solutions, we’re here to help with all of your management needs.  Our goal is to partner with our PCPs and health plans to ensure that a member’s case is being properly coordinated, adequate coding is being captured by PCPs, claim and encounter submissions are performed timely, utilization management and marketing sales and retention strategies are all in place.


We provide medical management services to over 50 primary care physicians throughout Florida. Our network coverage areas are centralized in Monroe, Miami-Dade. Broward, and Palm Beach County.

BENEFITS OF WORKING WITH PRIMARY HEALTH SOLUTIONS


As a team, we will enhance the quality of care that each member receives by providing indispensable medical management services for:

  • Facilitate credentialing paperwork for new and existing providers
  • Membership growth and retention strategies
  • Monthly HEDIS Reconciliation of measures
  • Provide recommendation for referral coordinators
  • Coordinate with health plans on all PCP related initiatives
  • Medicare Rish Adjustment (MRA) and Coding audits
  • Monthly PCP Performance reports:
  • Membership trends by PCP group
  • Medical Cost and Rx Spending
  • Hospital and ER Utilization
  • HEDIS Non-Compliant Measures
  • MRA Education
  • MRA Improvement Reports

MONTHLY MEDICAL REPORTS


As part of our managment services, we provide you with a Monthly Primary Health Solutions’ Medical Management Report, which gives you relevant, at a glance overviews of:

  • ER Utilization
  • Inpatient and Outpatient census
  • Rx utilization
  • Specialist utilization
  • MRA Scores
  • Provider Lineal

MEDICAL MANAGEMENT

The MSO Medical Management Team will serve as a medical conduit to liaise effective communication between the Plan, the Providers and the Members within several key focus areas:
  1. Improve provider and member quality of care/quality measures
  2. Promote the importance of adherence and persistence to treatment regimens
  3. Assist with coordination and transitioning of care
  4. Achieve cost-effective alternatives while not compromising care objectives

MARKETING GROWTH & RETENTION

Together we will create a marketing communication and sales campaign that is unique to your medical office and your community, providing opportunities for growth while retaining existing membership.

NEW MEMBER STRATEGY
  • Membership conversions
  • Co-branding Direct Mail communication
  • Events, such as, health education seminars, seasonal, etc.
  • Marketing promotion through social media, print advertising and radio
RETENTION STRATEGY
  • Targeted events, such as birthdays, holidays
  • Direct Mail, such as, personalized mail outs (birthday, center anniversary), health awareness, etc.
  • Educate Medicare patients on health plan services and benefits for informed decision making
  • Phone campaigns


PROVIDER PARTNERSHIP

  • Request for provider offices with opportunities
  • Sample success stories and projection for wholly owned centers
  • Assist with coordination and transitioning of care