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