Our Services and Programs
DHCM provides a full scope of Managed Care Organization/Health Maintenance Organization (MCO/HMO) management services and Healthcare Management Consulting Services, which are summarized below:
A. SUMMARY OF HMO/MCO MANAGEMENT SERVICES
- Enrollment, Education and Member Outreach
- Marketing, Health Education and Promotion
- Primary Care, Specialists, and Behavioral Services Provider Relationship Management
- Compliance Review of Covered Services and Other Benefits
- Provider Network Management
- Utilization Management
- Care Coordination and Case Management Programs
- Program Integrity Compliance Reviews
- Grievances and Appeals Program Reviews
- SDOH and Value-Added Services Programs
- MCO Administrative and Management Services
- Provider Claims Processing and Administration
- Electronic Medical Records Programs
- Provider credentialing and network management
- Predictive modeling and health risk stratification
- Coordination of benefits and third-party liability detection
- Capitation and risk management programs
- Member Services
- Member Eligibility Determination
- Member Enrollment and Disenrollment
- Member Recertification
- Prescription Benefit (PBM) Program Management
- EPSDT Compliance
- Laboratory Services Management
- Dental Services Provider Management
- Behavioral Health Services Management
- Chronic Disease Management Programs
- Non-Emergency Transportation Management
- Vision Care Management
- Health Risk Assessment
- Program Compliance
- Quality Management Programs
- Medical Management Reviews
- Provider Credentialing
- Provider Incentive Programs
- MCO IT Systems
- HEDIS Measures Compliance
- NCQA Accreditation Management
- Member Services
B. WELLNESS PROGRAMS
The Eight Dimensions of Wellness
DHCM and its providers and its wellness programs are focused on the following services:
- Stress reduction programs
- Weight loss programs
- Smoking cessation programs
- Health risk assessments
- Health screenings
- Exercise programs and activities
- Nutrition education
- Healthy Eating
- Diabetes Prevention and Management
- HIV/ADIS Prevention
- COVID Testing Prevention
- Teen Pregnancy Prevention
- Alcoholism Prevention
- Drug Addiction Prevention
- Physical Fitness Programs
- Family Counseling
- Personal Hygiene
- Self Esteem Development
- Food Supply Support
- SDOH Mitigation and Resolution
- Crisis Intervention Services
- Health Coaching
- Health Education and Training
C. SOCIAL DETERMINANTS OF HEALTH (SDOH) VALUE-ADDED SERVICES
The Social Determinants of Health (SDOH) are all of the external factors that affect our client’s members’ health and well-being outside of the doctor’s office, and these factors are critical for us to understand our client’s health care management needs.
Determinants: | Contributing Social Factors |
Food | Hunger, Access to Healthy Food Options, Food Deserts, Access to Healthy Restaurants, Lack of Nutritional Counseling. |
Economic Stability | Employment, Income, Expenses, Debt, Medical Bills, Support, Legal Barriers, Job Training |
Health Care System | Health Coverage, Provider Availability and Access, Provider Linguistic and Cultural Competency, Quality of Care, Behavioral Services, Homecare, Access to Pharmacy, Program Eligibility Issues. |
Neighborhood and Physical Environment | Housing, Transportation, Safety, Parks, Playgrounds, Walkability, Zip Code / Geography. |
Education | Literacy, Language, Early Childhood Education, Vocational Training, Higher Education, Computer Skills, Poor Public Schools, Poor Performing Children. |
Community and Social Context | Social Integration, Support Systems, Community Engagement, Discrimination, Gentrification, Smoking, Stress, Drug Addiction, Alcoholism. Abusive Relationships |
Our SDOH program processes will track the workflow of the Social Determinants of our client’s members’ health and the required social services, program management and coordination needed to remediate and remove these impediments to our client’s members’ health care. Our SDOH processes will identify and define the social and economic conditions and resources available in our client’s members’ homes, neighborhoods, and communities that impact their overall health and well-being.
D. HEALTHCARE MANAGEMENT CONSULTING SERVICES
- Management and Operations Consulting
- Business Planning for Healthcare Organizations and Providers
- Operations Compliance and Assessment
- Business Process Re-Engineering
- Patient Satisfaction Surveys
- Provider Satisfaction Surveys
- Management and Organizational Review and Restructuring
- Operational Reviews
- Risk Assessment & Risk Management
- Performance Management Planning
- NCQA Compliance Reviews
- Strategic Planning
- Performance Management
- HIPPA Compliance Reviews
- ESPDT Compliance Assessment and Performance Planning
- DELMARVA Compliance Reviews
- Systems Implementation Support
- HEDIS Compliance and Performance Planning
- Management and Operations Reviews
- Budget Reviews and Planning
- Change Management
- Quality Control Training
- Assessment of Utilization Management
- Assessment of Care Coordination Functions and Assessment of Case Management Program
- Assessment of Disease Management Program
- Assessment of Grievance and Appeals Procedures and Compliance
- Enrollment and Disenrollment Process Improvement Initiatives
- Assessment of Provider Incentive Payment Plans
- Assessment of Provider Network Adequacy and Expansion Planning and Implementation
- System Requirements Analysis for Healthcare Management Information Systems
- IT Systems Implementation
- Management Training and Planning
- Regulatory Compliance Reviews in accordance with Health Department Regulations
- Revenue Enhancement Consulting
- Cost Containment Consulting
- Public Health Community Engagement and Community Services Programs
- HMO Management Services
- Healthcare Personnel Recruiting and Staffing