Third Party Administrators

In an environment where every healthcare dollar must be accounted for, TPAs are leading the charge to reduce the high cost of employee benefits. This does not mean that they are willing to sacrifice care excellence in return for lower rates. The TPA business model is focused on providing access to innovative plan designs that incorporate quality health care providers and programs enabled by personal service; supported by effective health and wellness initiatives; delivered efficiently and cost-effectively.

Apollo solutions support these objectives by providing affordable access to fully-accredited, evidence-based guidelines that:

  • Reduce member expenses:
    Evaluate the appropriateness of care provided to identify and eliminate unnecessary procedures, treatments and admissions prior to delivery.
  • Deliver rapid ROI:
    Apollo clinical guidance technology is a fraction of the expense of other systems while offering similar content excellence.
  • Improve efficiency & productivity:
    Intuitive, user-friendly design allows utilization review and care management staffs to be more productive, with guidance that supports accuracy and consistency.
  • Improve clinical staff efficiency:
    Intuitive, user-friendly design allows for efficient and effective utilization review.
  • Provide Expert Support:
    A built-in mechanism allows users to ask a criteria-related question and receive a response within 24 hours or less.
  • Enhance staff satisfaction:
    Streamlined information displays deliver more meaningful content at a glance and eliminate frustrating click searches to find the right information.
  • Support comprehensive care management initiatives:
    Guidelines are available to support Ambulatory, Acute Care Inpatient, Physical/Occupational/Speech Therapy and Rehab, Behavioral Healthcare, Post-Acute and Extended Care encounters.
  • Help manage chronic, costly and common disease states:
    Clinical Guidelines for Primary Care (Medical and Obstetrical) and Clinical Behavioral Health highlight best practices and proven effective methodologies for treating diagnoses such as asthma, diabetes, smoking cessation, ADHD, etc.
  • Promote effective wellness initiatives:
    Identify “wellness” or preventive healthcare standards by age and sex relating to common medical and obstetrical disease states.
  • Maintain compliance:
    Provide care guidance that is backed by multiple accredited sources and clinical associations to meet regulatory requirements.
  • Target provider ‘outliers’:
    Those providers who continually operate outside established criteria and guidelines without justification can be targeted for educational programs.
  • Integrate with existing applications:
    A Microsoft .NET framework facilitates rapid integration with existing Utilization Management and Care Management systems or other applications.
  • Support Commercial & Government programs:
    Clinical review criteria guidelines and evidence-based benefit interpretations include benchmarks for commercial, Medicare and Medicaid populations.