Phoenix Medical Management
Workflow Optimization for Operational Excellence

T

he transition from transaction-driven healthcare to value-based models has steered into a new era of excellence, promising improved patient outcomes and cost-effective care delivery. However, hospitals still struggle with various challenges, like the influx of patients seeking admission for medical as well as social reasons and the denials of insurance payment.

Phoenix Medical Management redefines care coordination, denials prevention, utilization review, and more such programs for a spectrum of medical institutions, from small rural hospitals to large health systems. Embracing its motto, ‘Our solutions are standout, not standard,’ it focuses on improving resource utilization, avoiding care delays, and obtaining payments on time.

“We understand the role hospitals play in their communities and strive to help optimize their programs to assist them in better serving the public,” states Tiffany Ferguson, CEO of Phoenix Medical Management.

Comprising physician advisors, seasoned nurses, and accomplished social workers, Phoenix Medical Management’s nationally acclaimed team uses its frontline healthcare experience to transition into advisory roles. They guide diverse healthcare organizations in effectively overcoming the challenges they encounter in administrative operations and healthcare workflows.

In its process of transforming the various programs, the company adheres to three core tenets- assessment, transformation, and education.

During the assessment phase, Phoenix Medical Management conducts an in-depth scrutiny of the case management, utilization review, and denial/appeals programs to identify the areas that need improvement. Along with reviewing these internal factors, it also analyses external constraints like regulatory requirements and market dynamics.

Before diving into the transformation process, the team creates predefined project outcomes to compare with postproject results to ensure sustained success and ongoing effectiveness.

Subsequently, they put into action essential processes tailored to each client’s needs, which may include educating frontline staff, crafting, or updating policies, retraining staff and setting up data dashboards. It also assists hospitals in dealing with denials while the patient is still in the hospital and post-discharge through proper implementation of utilization review and physician advisory.

As part of education, the team offers various courses. The Case Management course focuses on the fundamental aspects of patient assessment and transition planning; the Utilization Review course covers the process of ensuring the proper use of medical services; and the Documentation Module includes information related to utilization review and clinical documentation integrity.

It further organizes online educational options for remote or rural hospital staff with limited access to physical sessions. These courses are approved for nurses, social workers, and case managers as their continuing education hours, aimed at addressing their skills and knowledge requirements, as mandated by state regulations.

To help clients manage various complexities such as social admissions, the team also conducts webinars, publishes articles, and offers educational resources.

The company’s core objective is to support clients in their existing state and facilitate progression toward their envisioned state of excellence. Every client may not need to go through all three processes. The team provides the level of support that the client requires after thorough analysis, data collection, in-person observation, and policy reviews. This transformative journey typically extends six months to a year, contingent upon specific contextual factors.

Showcasing its commitment to the industry, its expert staff has authored and co-authored various authoritative publications, including ‘Contemporary Guide for Hospital Case Management’ and ‘Hospital Guide to Contemporary Utilization Review.’ They actively collaborate with professional organizations, contribute to industry journals and newsletters, and engage with regulatory news bodies, further solidifying their dedication to the field.

Phoenix Medical Management offers practical solutions that optimize clients’ operations, combining its expertise and innovative approaches for effective community-focused care. With its support, hospitals can skillfully manage the present while shaping a future where excellence in care remains the driving force.