WAYS TO ENGAGE
We meet you where you are.
Your health plan is as unique as the people you serve. We’re passionate about sharing our expertise in the way that best works for you.
“I have worked with Toney Healthcare successfully in the past. They have high quality staff and consultants. They are very easy to reach and customize solutions to our needs.”
- Health Plan Executive
ADVISORY SERVICES
Consulting & Process Optimization
Drive initiatives, improve processes and productivity, and expand or install new functions with seasoned managed care executives and professionals who have extensive experience and a national perspective.
Working alongside your internal team, your Toney advisors not only evaluate and make recommendations but also help you apply them through instilling best practices and providing structures, templates, workflows, project plans, documentation and training.
We can help you build internal teams and install methodologies that endure beyond our engagement. We’re also here to deploy expert operators if needed until you’re ready to take over.
Most common advisory services focus on:
Clinical operations /
care management
Regulatory and
compliance
Quality
Accreditation
(NCQA, URAC)
Medical - Behavioral Health Integration
“I have worked with two outstanding senior executives from Toney Healthcare who both made immeasurable contributions and solved problems effectively.”
– Health Plan Executive
INSOURCE PARTNERSHIP
Dedicated Clinical Operations Teams
Rest assured that your clinical operations are being handled efficiently, effectively and compliantly with a comprehensive and dedicated Toney Healthcare team. Operating within your systems, policies and procedures, the team is managed by a seasoned, director-level Toney clinical operator.
Executing day-to-day operations, the team becomes an extension of your health plan, assuming full responsibility, including performance risk, for a medical management function (UM, CM, MOC, MPCM) for a line of business, population or specific benefit. We execute with a consultative approach to continually improve processes, day-to-day operations and program outcomes with our senior leader providing insights and reporting into your management team. Our teams are non-delegated and are dedicated to you.
Toney Insource Partnerships are typically a long-term solution (one year minimum) for health plans that have needs in discrete healthcare service areas, such as medical management for a Medicaid expansion.
Benefits
Rapid deployment wherever needed
Complete performance visibility – operating on your system
Full responsibility with SLAs/KPIs and no burdensome delegation oversight
No hiring, performance management or training burden for you
Easy to budget – predictable fixed fee or PMPM
No data transfers, system syncs or reporting delays
“There are many positives. Their consistency and reliability has allowed us to develop long-term relationships.”
– Health Plan Executive
STAFF AUGMENTATION
Resources in a Pinch
Ensure continuity of essential health plan functions by filling resource gaps quickly with high quality, experienced managed care professionals. Our team of clinical and non-clinical staff are available for specific, individual assignments or as functional teams for as long or short as needed.
Available Resources
Senior clinical leadership roles (CMO, CNO, SVP)
Medical management resources
Nurses, physicians, BH clinicians
Quality, compliance, non-clinical support
“We had a new line of business going live. We received 100K more members than we anticipated! I reached out to Toney at 4:30 p.m. and they convened a meeting within an hour to help us assess our needs. Within 2 weeks I had 10 Toney Healthcare nurses starting to supplement our workforce needs.”
– Health Plan Executive
AREAS OF EXPERTISE
Find an expert for any area of medical management.
We’ve been in the medical management industry a long time and faced the hurdles you’re facing. Our professionals can work alongside you in every aspect of your clinical operations.