Learn how Rethink can streamline utilization review and standardize the decision making process while monitoring member progress on an individual level.
By using Rethink’s Medical Necessity Assessment developed by industry leading behavior analysts and validated with over 11,000 assessments across 6,000 patients. The tool enables health plans to monitor quality care indicators, coordination of care, barriers to treatment and consistently apply ABA benefits and quantify responsivity to treatment.
With evidence-based treatment approach, including appropriate dosage of ABA therapy, utilization reviewers are able to make clinically sound decisions in a standardized, objective way. The structured elements in the MNA tool ensure a complete medical record is submitted by the provider, and reviewed by the health plan systematically.
By tracking and analyzing initial service authorizations, re-authorizations and quantifying responsivity to treatment, considering Social Determinants of Health, barriers to treatment progress, caregiver involvement and changes to standardized and ABA curriculum assessments, the health plan increases objectivity and accuracy in decision making and reduces opportunities for outcomes that lead to avoidable harm or wasteful allocation of resources.
With single-sign-on (SSO) capabilities that integrate with existing utilization management systems and a recommended dosage of ABA therapy, the Medical Necessity Assessment ensures inter-rater reliability between reviewers, pinpoints areas for case management and reduces communication barriers between payors and providers.
By collecting and analyzing quantifiable quality indicators within the Medical Necessity Assessment related to best-practices, identification of resource needs, coordination of care, client dignity, caregiver involvement etc., a cohesive and productive value-based care structure can be formed.
Related to provider performance as it relates to authorizing care and quality of service.
Automatically track rates of skill acquisition, behavior reduction and progress on ABA curriculum assessments (e.g., increases in VB-MAPP) along with Medical Necessity Assessment hours recommendations over time.
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