Trend Control and Quality Improvement Solutions

Trend Control

Our Fraud Waste and Abuse program is designed to improve clinical outcomes and lower total cost of care by providing prescribes and care teams the right information at the right time, allowing them to better coordinate care, minimize overuse and misuse, and address potential abuse of all controlled substances.

Our Electronic Prior Authorization (ePA) program includes an enterprise solution to streamline and manage prior authorizations, electronic prior authorization clinical rules management, distributed workflow, comprehensive document management, and member and physician portal support, delivering an end-to-end solution to support all lines of business.

Argus provides an integrated approach to Utilization Management to help health plans manage  the complexity of UM and reach their objectives.  Our standard UM edits are designed to promote the safe, rational use of drugs in areas such as quantity limits, age edits, gender edits, duplicate therapy, and Drug Interactions.

Quality Improvement Solutions

By using our solution, HEDIS measures can run on the standard calendar year as required by the National Committee for Quality Assurance (NCQA), and also on any user-defined analysis period. This provides health plans with a tool to continuously measure, monitor, and manage HEDIS rates throughout the year as well as to meet additional off-cycle compliance requirements.

Star5 is flexible solution Argus offers, allowing Medicare plans to implement a tailored star rating strategy. Components include analytics, a simulation dashboard, clinical interventions, and reports. We collaborate with Medicare plans to customize Star5, including the option of analytics or analytics plus interventions, to meet the unique needs of each plan.

The Argus Medication Adherence program offers health plans an efficient and accurate process to identify and stratify members, while applying risk-based metrics to prioritize members into appropriate levels of engagement. This approach allows health plans to focus on the right members at the right time to help maximize drug therapy in conditions where improved adherence to treatment is most likely to reduce total cost of care and improve ROI.