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Specialty Network Management

Managing client organizations with a specialty focus comprehensively

Specialty Network: Cost-Efficient Coordination of Stakeholders and Processes in Care Management

Since the mid-‘80s, specialty networks have gained momentum in capturing segments of the patient populations that are aligned with health maintenance organizations and other insurers. Their goal is to provide a more focused and cost-effective approach to care while serving a more engaging patient experience. In the ongoing evolution of the healthcare market and continued medical cost pressures, specialty networks embrace new opportunities in their approach to care and cost management.

We Provide a Purposeful Approach for Many Specialty Network

Behavioral health organizations

Eye care focused providers

Surgery-based specialty networks

Orthopedic network solutions

Dermatology centric organizations

Specialty Network’s Approach that QC7 Supports

Manage and customize provider panels to manage patient volume

Establish comprehensive benefits configuration and control

Design customized care management plans

Streamline utilization management of auto referral process

Create intelligent auto claim adjudication and workflow routing schemes

Build fee-for-service and capitation-based reimbursement structures

Manage stop loss configuration and reporting

Integrated evidence-based care guidelines

Generate audit and reporting management

Connect via HIPAA-based EDI functionality with health plans and providers

Manage via executive and department level dashboards and actionable oversight

Configure shared and full-risk Division of Financial Responsibilities

Identify providers with specified characteristics and within a radius of a given member

Why QuickCap for Specialty Networks?

Today, QC7 provides an advanced infrastructure that specialty networks require for care and process management, whether from a traditional fee-for-service perspective or from a more comprehensive value-based environment. Seamlessly aligning departmental workflows is QC7’s underlying framework designed for managing a myriad of specialized risk-based provider networks.

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