Medical Management Program
HDMGS reviews medical management programs and contractors responsible for delivery of these programs. We measure and assess protocols and processes and ensure that medical management is efficient and the program produces intended outcomes. We measure total membership participation in and opportunities for increasing member participation. HDMGS also reviews files and tests the evaluation criteria to determine the process for engaging and administering care as part of medical management and determine if it was handled correctly.

Disease Management
HDMGS determines the accuracy and effectiveness of disease management (DM) contractors. Many government health programs are contracting with third-party vendors to complement cost containment programs for improving care, preventing medical errors, reducing unnecessary hospitalizations, and lowering medical costs for enrollees with a targeted disease state — asthma, congestive heart failure (CHF), coronary artery disease (CAD), and diabetes. HDMGS performs a comprehensive evaluation of the accuracy and effectiveness of these programs. The evaluation includes an audit of the DM program to measure the performance and effectiveness of the DM, as well as, an evaluation of operational controls to identify improvement opportunities.