Physician Led Medical Management
A unique solution to medical management

At MHHNP, we place responsibility for medical management in the hands of those who know best – experienced, practicing physicians. Backed by an integrated data system and nationally recognized guidelines and resources, MHHNP’s physician-led medical management program ensures the best and most appropriate coverage for your employees and greater cost savings for you. The program provides physician-to-physician management and oversight including:

• 16 best practice committees made up of over 300 physicians
• Quality reviews by three full-time, practicing medical directors with over 20 years of experience each
• Utilization reviews including appropriate length of stay, medical necessity, UR declinations, and appeals
• Plan design oversight
• Physician-developed pharmacy formulary
• Physician-approved policies and procedures
• Review of quarterly experience reports to identify data & trends
• Pre-certification, case management and claim adjudication integrated in one efficient data system.
• A professional case management team using industry-standard guidelines
• InterQual criteria for determining medical necessity for both inpatient admissions and outpatient procedures
• The Solutient Western Region 50th percentile to determine the appropriate length of stay

Our clients have achieved significant cost savings through this aggressive, integrated approach.

MHHNP PPO vs. National Average

To find out how you can achieve similar results for your company, please contact us at 713-448-6928, or by e-mail Brent.Schultz@memorialhermann.org