TCS Healthcare Technologies offers a wide variety of care management solutions catered to the needs of nurse case managers. We offer utilization, referral, case, disease, population, quality management systems along with clinical programs, stratification and automation tools to help your workflows suceeed. Below is a list of what we have avalible through our ACUITY Suite.

Utilization Management


The ACUITY suite of products is designed to fully support all utilization management functions including:

  • Prior Authorization
  • Concurrent Review
  • Retro Review
  • Criteria Application
  • Evidence-Based Guideline Application
  • Medical Review
  • Peer to Peer Review
  • Appeals
  • Metrics Reporting

 

Referral Management


The ACUITY suite of products offers full support of a variety of referrals management processes including:

  • Notification
  • Specialty Referrals
  • Benefit Carve-outs
  • Network Management
  • Metrics Reporting

 

Case Management


The ACUITY suite of products provides the flexibility to design business specific case management workflows, which can include:

  • Stratification/Identification
  • Automated enrollment, task creation, and letter generation
  • Screening Tools
  • Assessment Tools, including branching logic and scoring
  • Care Plans
  • Short-term, transactional programs
  • Long-term case management programs
  • Multi-disciplinary team management
  • Care collaboration
  • Patient communication and education
  • Metrics Reporting
  • Clinical Outcomes Measurement
  • Transition of Care Programs

 

Disease Management


The flexibility of the ACUITY suite of products provides for the development of customized disease management programs, which can include:

  • Stratification/Identification
  • Automated enrollment, task creation, and letter generation
  • Screening Tools
  • Assessment Tools
  • Care Plans
  • Short-term, transactional programs
  • Long-term case management programs
  • Multi-disciplinary team management
  • Care collaboration management
  • Patient communication and education
  • Metrics Reporting
  • Clinical Outcomes Measurement
  • Program Measurement

 

Population Management


The ACUITY suite offers functionality and clinical content to manage entire populations as well as to identify and manage sub-populations via:

  • Stratification/Identification
  • Automated enrollments, task creation, and letter generation
  • Gaps in Care Mining
  • Assessments and Care Plans for
    • Physical activity and general fitness
    • Nutrition and diet
    • Depression/substance abuse
    • Weight control
    • Smoking cessation

 

Quality Management


ACUITY includes Role Based Security and privacy controls, which allow for the confidential management of sensitive workflows including:

  • Quality of Care Case Review
  • Appeals
  • Grievances
  • Metrics Reporting

 

Clinical Programs


TCS offers a variety of clinical programs (AcuCare Programs), which include initial and ongoing assessments, care plans, and educational materials for the most recognized, chronic, high cost conditions including:

  • Asthma
  • COPD
  • CHF
  • CAD
  • Diabetes
  • High Risk Pregnancy

 

Stratification and Automation


TCS’s stratification and automation tool, AcuStrat, allows for the creation of customized business rules as well as “out of the box” functionality including:

  • 21 pre-configured filters
    • Identify gaps in care
    • Identify non-adherence issues
    • Identify 30 day readmissions
    • Manage eligibility changes
    • Identify candidates for care management
    • Identify quality issues
  • 10 pre-configured automated actions
    • Create/update authorizations
    • Create/update tasks to drive workflows
    • Create specific notes and emails
    • Enroll/update patients in care programs
    • Update patient records
    • Create and send emails
    • Queue correspondences 
  • Reads distributed data sources
    • Labs
    • Claims
    • Pharmacy
    • Eligibility
    • And more