Care Management

Manage and engage members. Optimize Care. Improve Outcomes.

Whether you need guidance, complete care management programs, or resources to fill your staffing gaps, Toney Healthcare offers deep expertise for all your care management needs. Our consultants, all appropriately licensed with health plan expertise, can be quickly deployed to support medical, behavioral, integrated and specialized care management across all lines of business and population types.

We operate on your platform, so deployment is quick, activities and outcomes are transparent, and all data stays in your control. 

Optimize Programs—or Launch New Ones

Our clinical experts have years of best-practice experience in all aspects of care management, and can optimize your strategy, programs, processes and systems to ensure they’re effective, efficient, and compliant. We can help you expand into a new geography or line of business, launch new programs, more effectively support social determinants of health (SDOH) and behavioral health (BH) in a holistic approach to care, and more.

Toney Healthcare also offers a range of unique, highly effective plug-and-play care management programs that focus on a health plan’s highest risk/cost and rising-risk members to reduce avoidable utilization, lower costs and improve outcomes. These programs can be deployed individually or as a comprehensive risk management program.

Improve Outcomes With Expert Execution

We quickly deploy expert frontline and management resources—including leadership, clinician care managers, coordinators and community health workers—to fill critical resource gaps, improve outcomes or get programs off the ground. Because we operate on your platform, our work is completely transparent and immediately available for reporting. Two service models are available:

Staff Augmentation— Our experienced clinical and non-clinical professionals are available for specific, individual assignments or as functional teams to ensure continuity and smooth care management operations. This program is ideal if you’re short-handed or need a few experts for a limited time.  

Insource Partnership—We execute the program for you as an extension of your health plan, providing a full team as a dedicated unit, from leadership to frontline clinical operators (RNs, physicians, behavioral clinicians) and support staff. Led by a senior clinician who reports to your leadership, our teams are accountable to performance metrics and handle all personnel matters and training.

Operational Execution

  • Medical, behavioral health, and integrated case management in all lines of business

  • Specialty care management programs including high-risk/high-utilizer, substance use disorder, ABA management/autism spectrum disorder, MLTSS, IEP, dementia and more

  • Med-psych care management approach for chronic conditions exacerbated by underlying behavioral health and psychosocial issues

  • Support for all SNP types (D, C, I) – MOC 2: Care Coordination

  • Member and provider engagement via field-based care managers and community health workers

Advisory Services

  • End-to-end assessment of care management strategy and programs

  • Development and implementation of case/care management programs for new and expanding plans

  • Organizational redesign to remove siloes and improve collaboration across interdisciplinary teams (e.g., medical-BH integration)

  • Quality performance improvement, data analysis and reporting aligned with NCQA, CMS, URAC, and other regulatory requirements, corrective action plan resolution and auditing support

  • Process optimization and tool alignment to improve efficiency, save costs, support best practices and compliance, and ensure optimal usage of clinical and non-clinical support staff

  • Tailored population health support for identification/stratification, engagement and intervention

  • SDOH and BH integration for member-centric whole-person care, including community resource identification

Let Us Engage Your Members

Combine telephonic outreach with boots on the ground to connect with hard-to-reach members and keep them engaged with your care management program. Toney Healthcare can deploy field-based care managers and community health workers with local expertise to provide support, perform assessments and view living conditions (e.g., safety concerns, slip-and-fall hazards, cooking and food security issues) to identify social and behavioral determinants that can be built back into the care plan. We leverage your processes and tools to make sure all interactions are fully documented and available for reporting so you can see progress and pass your audits.

Why Toney Healthcare?

  • Industry-leading clinical operations with deep best practices expertise

  • National and regional perspective on care management best practices

  • Extensive line-of-business CM expertise (Medicare Advantage, Medicaid, SNP, MLTSS, TRICARE, Commercial/ACA)

  • Rapid implementation, plug-and-play health management services to ensure speed to value

  • No recruiting or hiring burden, plus optional management oversight

  • Medical and behavioral health support

  • Complete transparency and reporting by working within your system

  • Full accountability for meeting performance metrics for productivity, quality and performance when managed by Toney Healthcare

  • No burdensome delegation oversight

  • Platform-agnostic with broad knowledge and experience on all CM platforms

Sampling of Past Engagements

  • Optimized and delivered Medicare/SNP case management program to overcome plan’s failed audit

  • Delivered comprehensive case management program for large Blues plan’s out-of-state members

  • Rescued Medicaid care management program from poor-performing partner to avoid penalties, resulting in ~2X productivity and very high quality

  • Transitioned behavioral health case management in-house from a segregated, outsourced model

  • Designed, developed, implemented and executed MLTSS program

  • Deployed VP of Care Management to assess and optimize programs and provide leadership for over 1 year

  • Provide face-to-face engagement and transitions management via community health workers

  • Provide analytics resources for analysis, identification and stratification to target at-risk members for care management programs

  • Deployed VP of Care Management to lead Tailored Plan care management integration and execution

Ready to learn more?

Toney Healthcare’s team of experts is ready to help you address your care management requirements with advisory services and plug-and-play health management resources so you get the help you need, fast—and without HR headaches.

Toney Healthcare’s team of experts is ready to help you address your utilization, care and behavioral health resource needs with plug-and-play health management services and expertise so you get the help you need, fast—and without HR headaches.

End-to-End Utilization Management