Insource Partnership
Dedicated Clinical Resources.
Led by Toney Healthcare. Working in Your Systems.
Toney Healthcare’s Insource Partnership program brings dedicated clinical operations teams and advisory services to health plans and other risk-bearing organizations to improve the implementation, management, staffing and growth of critical healthcare programs like utilization and case management.
Dedicated teams. Full accountability.
Our team of professionals elevates clinical operations, taking responsibility for a medical management function for a population, business line or benefit that is underserved, new or expanding. We work as an extension of your health plan, fully integrated within your operations, as a dedicated team—frontline clinical resources and support staff led by Toney Healthcare.
Deep expertise in best practices, policies, procedures and strategic planning helps map the methodology that best achieves your objectives and improves processes, day-to-day operations and outcomes. This collaborative approach ensures your operations are efficient, effective and compliant.
Our Insource Partnership program is a long-term solution—typically one year or more—for a discrete healthcare service area in medical and behavioral health. We work within your ecosystem and on your platforms to ensure transparency and full visibility into team and business performance.
Why Toney Healthcare?
Industry-leading clinical operations with deep best practices expertise
Rapid implementation, plug-and-play health management services to ensure speed to value
No hiring, performance management or training burden
Medical and behavioral health support
Complete transparency and reporting within your system
Full accountability for meeting performance metrics
No burdensome delegation oversight
Easy, predictable budgeting as a PMPM or flat rate
Our Programs
Utilization management spanning comprehensive UM, 24/7, after-hours, specialty programs, physician review, appeals and grievances, medical and behavioral health
Case management for all levels of medical and behavioral health, including acute, complex and specialty care such as MLTSS
Med-psych and integrated care management comprising physical and behavioral care management to support psychosocially compromised and chronically ill individuals
Model of Care (MOC) management (all SNP types: I, C, D)
Specialty care management—Specialty expertise for substance use disorder, ABA management/ autism spectrum disorder, MLTSS, IEP and others
Population health management for chronic conditions and diseases
Quality and compliance support for CMS (Stars, QRS,HOS), NCQA (HEDIS®, CAHPS®), URAC, audits, accreditation and other quality performance programs
Efficiency. Expertise. Empowerment.
Integrated Partnership
We bring expertise and services as an integrated member of your team to empower you with complete visibility and control of all program activities and outcomes. Our experts help you transform your programs from the inside by evaluating operations, making recommendations and implementing best practices for all you do—workflows, policies and procedures, care plans and assessments, performance metrics, compliance programs and much more. Plus, the insource model eliminates the complicated delegation and oversight requirements of outsourced programs, making contracting and execution much easier.
Plug-and-Play Expertise with Toney-Led Teams
We leverage our deep expertise in managed care operations, quality, and regulatory compliance to become a seamless, integrated component of your operations, extending your capabilities so you more effectively support member needs. Our teams are composed of seasoned clinical operations executives, nurses, social workers, behavioral health clinicians, allied health and non-clinical support, primary care physicians, psychiatrists and more, all with health plan experience. Teams are managed by Toney Healthcare clinical directors who maintain a frequent onsite presence and are fully engaged as part of your clinical operations leadership team to ensure alignment with strategic and operational direction. This approach eliminates your burden of recruiting, onboarding and training resources and managing the team’s performance.
Your Way, Your Platform
We become part of your team, fully integrated with your operations from a data, workflow, resource and oversight perspective to avoid segmented or siloed processes. And we work within your systems so you have full visibility to monitor performance and generate accurate reports for key metrics without data transfers, system syncs or reporting delays.
Rapid Deployment
We deploy seasoned operational teams, including leadership, typically within 30 days of contract execution. After onboarding using your plan’s training curriculum, we are fully up-to-speed and ready to deliver results.