Medical Management
Case Management That Moves The Needle.
Take the guesswork out of managing healthcare costs with clinical oversight that improves care and controls spending.
Lower costs. Better Care. One Partner.
Decrease in Emergency Room Utilization
Decrease in Admissions
Reduction in Cost per Member
Benefits
Behind-the-Scenes Support with Frontline Impact
From care coordination to high-cost case oversight, we're a trusted partner focused on quality, cost, and your long-term success.
With the right clinical oversight and redirection of care, you can reduce unnecessary claims, avoid high-cost services and allocate resources where they matter most—without sacrificing care quality.
Effective coordination ensures members receive timely, appropriate care-avoiding delays, confusion and unnecessary interventions while improving long-term health.
Identifying at-risk members early allows for targeted support—improving outcomes and reducing avoidable ER visits, hospital stays and future high-cost claims.
BHPS's URAC-accredited utilization management programs promote the delivery of medically necessary and cost-efficient healthcare. Through individual case reviews and comprehensive care assessments, they ensure members receive appropriate, cost- effective care.
Core Services
Stronger Oversight.
Smarter Spend.
Better Results.
From utilization reviews to hands-on case support, our clinical services direct your members to the right care while helping you manage costs more effectively.
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Utilization Management
Ensure appropriate care, reduce unnecessary costs and support members at every stage of treatment
The BHPS utilization management program promotes high-quality, medically necessary and cost-efficient care through individualized case review. Using our custom-built platform, we assess treatment at every stage to ensure members receive appropriate care without added delays or costs.
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Case Management
One-on-one support for complex cases—tailored to each member's unique needs.
The BHPS case management program provides personalized support for members facing complex or catastrophic conditions. Through direct outreach, our clinical team builds one-on-one relationships to understand each member's challenges, coordinate their care and guide them toward better health outcomes, while helping reduce avoidable spending and high-cost events.
Customer Quote
Having a partner that understands both the clinical and financial side of care has made a measurable difference in how we manage high-cost cases.
— Chief Operating Officer, Self-Funded Organization
Core Services
Additional Clinical Programs That Expand Your Impact
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Pharmacy Benefits Management (PBM)
Manage prescription costs without compromising care. Our PBM services integrate with your health plan to improve medication oversight, reduce spend, and streamline administration.
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Care Coordination Programs
Help members access high-value care with confidence. We assist with scheduling for complex services, like MRIs or genetic testing, to ensure members see the right providers at the right cost.
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Pain Management & Opioid Oversight
Promote safer pain management strategies and reduce the risk of opioid dependency. Our program combines clinical oversight and member education to improve outcomes and lower drug costs.
Resources
Insights on Smarter
Healthcare Administration
Ready to Take Control of Your Medical Management Strategy?
Discover how integrated medical management services from BHPS can help you improve care, reduce costs and deliver a better member experience.
