Utilization Management

HDP was founded as a utilization management firm 20 years ago. We are recognized as an industry leader in this field, with care management programs. We believe that patient advocacy rather than care denial provides the foundation for greatest long term cost effectiveness.

Utilizing a primary nurse model, the utilization management nurse is responsible for pre-certification services and continuing through concurrent review and discharge planning. The same registered nurse, helps members navigate an increasingly complex system and preventing gaps or overlaps in care.

The result is lower overall medical costs by delivering the appropriate amount of care, at the right time, at the right place, by the right provider and at the right cost.

Milliman USA Care Guidelines®

HDP uses the Milliman USA Care Guidelines®, which is a clinical criteria set that spans the continuum of patient care in a variety of care settings. In addition to Care Guidelines, the nursing staff has access to a board-certified medical director and a committee of local medical advisors who provide clinical guidance to all aspects of the Utilization Management and Case Management programs.