Monroe Plan for Medical Care
The Perfect Partner for Optimizing Population Health

Rising medical costs impact employers, insurers, and individuals. Specially tailored Utilization Management programs can provide relief to these rising costs by ensuring that individuals are receiving the right care, at the right time in the right setting.

Monroe Plan for Medical Care is uniquely qualified to help other organizations achieve the goal of balanced care while meeting ever-increasing regulatory requirements.

Monroe Plan for Medical Care is a non-profit healthcare organization with over 50 years of experience helping individuals and families dependent on government-sponsored health insurance. Providing a full suite of population health management services, Monroe Plan’s expertise includes care management, utilization management, and an advanced healthcare analytics and reporting platform designed to support value-based arrangements focused on medical cost management and quality care.

Monroe Plan has a robust, NCQA accredited Utilization Management Program that efficiently conducts pre-service, concurrent, and post-service reviews for all categories of Medical and Behavioral Health services. In addition, Monroe Plan is a registered Utilization Review Agent through the New York State Department of Health.

Monroe Plan consistently uses national, best-practice, evidence-based criteria for reviewing all services. As a result, the reviews conducted by Monroe Plan receive 100% Inter-Rater Reliability scores and yield superior performance on chart and regulatory audits. Prior authorizations and customer support are provided by a best-in-class call center operation that consistently meets or exceeds all customer service level agreements and metrics such as speed-to-answer and first-call resolution.

As an organization founded by physicians, Monroe Plan is very adept at communicating and collaborating with physicians on behalf of their clients. Monroe Plan offers the value-added service of providing effective care management services to complex and high-cost populations leading to better health outcomes and reduced long term medical costs.

Monroe Plan brings a unique and comprehensive understanding of the healthcare landscape to their Utilization Management programs. In addition to offering services to other healthcare organizations, Monroe Plan operates an Independent Physician Association (IPA) affording their team a provider perspective on healthcare-related issues. With previous experience operating a health plan and current management of a leading care management agency in New York, Monroe Plan’s has a 360-degree, first-hand understanding of the challenges that healthcare organizations face today. When it comes to utilization management, this broad experience makes it easy for Monroe Plan to identify cost trends, design interventions to address the areas of improvement, and guide clients on how to move forward.

“We recognize utilization trends and work with our partners to implement best practices to implement cost effective solutions and quality outcomes,” says Kim Hess, COO at Monroe Plan for Medical Care.

One client sought out Monroe Plan after having regulatory and compliance challenges with their existing review agent. Monroe Plan was quickly able to turn the situation around and that client is now fully compliant with New York State Department of Health regulations scoring 100 percent on all audits. Monroe Plan recently won a bid to provide residential review services for a New York State agency for a complex population and has earned early accolades for quickly and effectively designing and structuring a program and services needed for this client. The organization’s quality of work, communication, and ability to meet stringent timelines and metrics secure long-term relationships with clients, lasting decades.

Monroe Plan’s overarching mission is to support individuals served by government sponsored programs to improve their health status. By serving this mission, Monroe Plan has made a real difference in improving health care disparities for highly challenged populations in the communities we serve. In so doing, we have built broad expertise managing the quality and cost of care for medically complex populations that healthcare organizations of all types will find beneficial.