Utilization management expertise strengthens collaboration and engagement to elevate care experience
TAMPA, Fla., Nov. 7, 2023 /PRNewswire/ — Toney Healthcare today announced that it has extended its partnership with St. Vincent Catholic Medical Centers Uniformed Services Family Health Plan (USFHP) to include the entire process of medical utilization management. USFHP supports approximately 13,000 beneficiaries of the Department of Defense-sponsored TRICARE Prime program located in New York, New Jersey, Pennsylvania and Connecticut. TRICARE Prime is available to military families and retirees.
The companies’ two-year collaboration has centered around a dedicated team of nurses and physicians providing medical necessity review to ensure that USFHP members receive high-quality and appropriate care. The partnership is now expanding to include an entire suite of utilization management services spanning customer service, intake, case setup, clinical review, physician review, appeals and fulfillment to continue driving efficiency, quality and clinical consistency. Toney Healthcare is also working closely with USFHP on technology transitions that will further enable the health plan to better support its members and provider community.
“As a trusted partner, Toney Healthcare ensures our utilization management program is managed efficiently and accurately so we can focus on the important work of improving outcomes for our members,” said Jeffrey Bloom, CEO of USFHP. “Our collaboration with Toney Healthcare ensures compliance, improves engagement and enhances the experience for all the people we serve.”
The Toney Insource Partnership model provides a dedicated and comprehensive team of experienced clinical and non-clinical staff to deliver and manage clinical operations and improve processes without the hiring, performance management or training requirements of building an in-house team. Toney Healthcare works as a dedicated extension of USFHP, operating on the USFHP systems with full visibility and responsibility for key performance metrics without the burden of delegation oversight. Its proficiency with industry and USFHP processes and protocols and the flexibility in meeting USFHP’s unique needs for benefits and membership supports efficient, effective and appropriate care.
“Toney Healthcare rapidly deploys highly skilled clinicians who are already experts in what we need them to do,” said Dr. Roberta McNeill, M.D., Chief Medical Officer of USFHP. “The Toney Healthcare team consistently exceeds our expectations in delivering high-quality, timely, clinically correct decision-making to support our members and providers.”
“Supporting the front lines of a health plan’s operations requires deep collaboration and a high level of trust and partnership to ensure members receive quality care at the right time and place to improve outcomes,” said Dr. Sam Toney, CEO, of Toney Healthcare. “Widening our relationship footprint is testament to our deep expertise and USFHP’s satisfaction with the quality results we’ve achieved.”
About Toney Healthcare
Toney Healthcare brings peace of mind to health plans’ clinical operations. Through guidance, leadership and talent, we provide expertise in all aspects of medical management, including operational execution, quality, accreditation and compliance. Our team of over 350 individuals includes nationally recognized subject matter experts, physician advisors, senior nurse executives, frontline clinical operators and other specialists. We have experienced the challenges and opportunities that risk-bearing entities face and provide seasoned resources and best practices tailored to the unique needs of each organization and the populations they serve. Headquartered in Tampa, FL, Toney Healthcare serves health plan clients nationwide in all lines of business. For more information, visit www.toneyhealthcare.com.
SOURCE Toney Healthcare