Peace of mind for your clinical operations.
Medical management guidance, leadership and talent to support your mission and elevate your operations.
Serving Medicaid, Medicare Advantage, TRICARE, Special Needs and Commercial health plans in all 50 states and PR with US-based experts.
Tailored advisory and resource solutions when and how long you need us
Fast deployment, with local, regional and national perspectives
Full transparency and efficiency by operating on your platforms
Unparaleled industry experience and support.
From advisory services to full operational teams, we’re here to help with solutions for medical, behavioral and specialty benefits for all plan types and lines of business.
Utilization Management
Physician Review Services
Case Management
Model of Care (C,D,I-SNP)
Med-Psych Care Management
Regulatory and Compliance
Specialty Care Management
Quality Improvement, Measurement, Assurance
Accreditation
Population Health
We meet you where you are.
We’re passionate about sharing our expertise in the way that best works for you.
STAFF AUGMENTATION
Resources in a Pinch
Fill resource gaps quickly with high quality, experienced managed care professionals for as long or short as needed.
• Senior clinical leadership roles (CMO, CNO, SVP)
• Clinical management teams and resources
• Nurses, physicians, behavioral health clinicians
• Quality, compliance, non-clinical support
INSOURCE PARTNERSHIP
Dedicated Clinical Operations Teams
For longer term solutions, experience a dedicated, comprehensive Toney team leading and executing day-to-day operations as an extension of your current capabilities. Your clinical operations will be executed efficiently, effectively and compliantly by managed care experts.
• Rapid deployment nationwide
• Complete performance visibility
• No hiring, performance management or training burden for the plan
• No data transfers, system syncs or reporting delays
• Full responsibility with SLAs/KPIs
• No burdensome delegation oversight
• Easy to budget — predictable fixed fee or PMPM
ADVISORY SERVICES
Consulting and Process Optimization
Drive initiatives, improve processes and productivity, and expand or instill new capabilities with a dedicated team of seasoned managed care executives and professionals.
Clinical operations/care management
Regulatory and compliance
Quality (QI, HEDIS, Stars)
Accreditation (NCQA, URAC)
Medical-Behavioral Health Integration
Payment Integrity, Risk Adjustment
Problems We Solve
With years of managed care experience, we understand the challenges plans face across lines of business and population types, bringing expertise to Medicare Advantage, Medicaid, Special Needs, TRICARE and Commercial / Marketplace organizations. Problems we address include:
Clinical and non-clinical resource shortages or performance concerns in utilization management (UM), care management (CM) and quality/audit functions
Lack of care management and utilization management expertise or leadership
Need for physician reviewers or other physician executives (including interim CMO)
Regulatory and compliance shortcomings (e.g., auth TATs, case backlogs)
Segregated behavioral health management and a desire to integrate
Lack of accreditation direction or readiness
Poor member health outcomes and care gaps
Lack of expertise in specialty health management (e.g., ABA, PT/OT, SUD, etc.)
Insufficient quality score (HEDIS, Stars) measurement and improvement strategies
Need for support in designing, developing, implementing and executing MLTSS programs
Shortcomings in field-based community health workers and care managers
Our consultants include a broad range of experts: senior leaders, front-line managers and operators, physicians and nurses (med/surg and psych), behavioral health clinicians (LCSW, LMFT, etc.), quality improvement, accreditation and compliance experts, community health workers, non-clinical support staff, analytics professionals, risk adjustment experts, certified coders and more.
In every engagement, our team takes a consultative approach to help our customers continuously improve day-to-day operations and program outcomes.
We’ve been there.
With years of managed care experience, we know the challenges and opportunities you face. Since 2008, we’ve been supporting the needs of health plans with seasoned clinical experts to tailor the industry’s best practices to each organization.
People first
We serve with humanity and empathy
Best practices
We openly share our knowledge and extensive national experience.
Alignment
We align priorities and goals to strengthen your healthcare ecosystem.
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.