We are your Ground Game for Member Location, Outreach, Engagement, and Delivery of Comprehensive Case Management Services Delivered in the Home and Inpatient Settings that Produce Outcomes Well Above Industry Standards. No one in the industry has a higher Engagement Success Rate than SMM. Our Care Management Services have been recognized by State Organizations and Industry Trade Groups for our Successes.
We have capability to deploy face-to-face comprehensive case management services in all settings and all geographical areas. We can deliver case management services at any time in the amount you need providing timely turn around and best industry outcomes.
We can initiate new services for you within five (5) to seven (7) days including training, tool creation and scheduling. SMM provides as much or as little care management services to meet your needs and goals. Let us be part of your work plan and never miss compliance, quality or financial goals again.
SMM has comprehensive compliance and quality improvement programs that meet all CMS and NCQA requirements for health plans, ACOs and Provider Practices. We exceed CMS and NCQA compliance for data security practices and meet all HIPAA and HITECH requirements.
SMM Face-to-Face Case Management Services are an effective and affordable solution for health plans to achieve their productivity, compliance, quality, financial, and member outcomes.
An Experienced RN, LMSW, or APRN can perform all assessments in the home or inpatient setting:
We have a 100% approval rate for 1915(c) Waiver Applications. We do not get paid until the Waiver Application is approved. We have worked with Long-Term Services and Supports for over 20 years. We can manage Personal Care Services including assessment and time adjustment with supporting documentation. Nursing Facility Level of Care Determinations with supporting documentation in the community or nursing facility.
SMM has case managers trained and experienced in evidence-based transitions of care who provide face-to-face effective transitions in the Inpatient, ED, SNF, and Home setting. We deliver successful transitions outcomes and have the lowest 30-Day All-Cause Readmission Rate in the U.S.. Ask about our ED diversion service.
We have certified LMSW therapists for onsite Behavioral and Crisis Management. Coupled with Virtual Access to Psychiatrists, SMM can intervene effectively and provide accurate assessment, medication adjustments, and therapeutic intervention preventing costly ED and Inpatient services. If hospitalization is required, our Therapists and Psychiatrists can help manage LOS.
Our APRNs and Physicians are experienced in HCC RAF and HEDIS assessments and interventions to optimize scores and keep you compliant. We ensure that you achieve optimal reimbursement that meets all CMS regulatory standards and is defensible. Let us show you how we can rapidly provide the support you need to maximize revenue capture.
SMM began as a solution developed by experienced health care professionals and IT professionals who have spent many years in health plan operations, clinical operations, IT, and quality to address the highest need members in a population. By combining clinical, operational and IT expertise to deliver direct care management at any level-of-care and on demand, we outperformed other providers of care management services. We spent years with care management vendors, some national, who were unable to deliver results to help us meet our financial, productivity, compliance, and quality goals. We decided to change that and created SMM. SMM is successful in providing results-driven care management services to health plans that have exceeded their metrics and goals. We can do the same for you.