Why SecureCare?
SecureCare is a provider-owned network management company advocating for conservative care providers. Our mission is to reinvent healthcare network management.
Simple, efficient, and fair – these are SecureCare’s values. We operate transparently and ethically by building deep, lasting relationships founded on trust and respect with providers and health plans. This balanced approach has proven to forge productive win-win partnerships.
SecureCare focuses on four core objectives:
- Eliminate prior authorizations
- Educate outliers
- Improve relationships
- Protect patients and providers
Health Plan Benefits
SecureCare Model
Our technologically driven, state-of-the-art platform provides health plans with a scalable, efficient approach to clinical review, credentialing, and ongoing oversight. We help plans strengthen clinical and financial management, improve consistency in decision-making, and identify opportunities to reduce unnecessary healthcare expenditures. Importantly, our model delivers these capabilities without requiring traditional prior authorization, helping health plans achieve greater oversight and cost management without restricting access to care.
Clinical Review
Our proprietary clinical review system gives health plans a data-driven approach to identifying and addressing fraud, waste, and abuse, as well as unnecessary or inappropriate utilization. Through consistent clinical criteria, advanced technology, and ongoing monitoring, we provide health plans with meaningful oversight of clinical performance and utilization without relying on prior authorization requirements. This enables plans to proactively manage risk and healthcare costs while maintaining an efficient, streamlined approach to clinical review.
Cost Management & Plan Performance
SecureCare’s business model is designed to help health plans achieve greater control over healthcare costs through technology-enabled clinical oversight. By applying standardized clinical review, continuous monitoring, and data-driven analysis, we help plans identify cost-saving opportunities, address unnecessary utilization, mitigate financial and clinical risk, and improve operational efficiency. The result is a proactive model for managing healthcare spend that does not depend on prior authorization as the primary mechanism for cost control.
Provider Benefits
Network Management
SecureCare utilizes a targeted approach. We are a data-driven company that analyzes key performance metrics to identify outlier providers. This approach decreases unnecessary administrative burdens for the majority of clinics without disrupting overall patient care. SecureCare focuses on outlier clinics by establishing the necessary steps for those clinics to comply with our requirements. This includes improvements in the areas of documentation, correct coding and billing, and patient management.
Less Administrative Burden
Most providers are able to care for patients without excessive oversight. In addition, SecureCare does not require prior authorizations unless mandated by the insurance company. In that case, all prior authorizations would be handled by the health plan, not SecureCare.
Performance Reporting & Clinical Review
SecureCare manages the network based on the analysis of key performance metrics. Clinics have access to a secure, online monthly report card that allows them to view their performance, make comparisons to their peers, and review network benchmarks. If needed, SecureCare performs peer-to-peer medical record reviews. This ensures that providers receive detailed support and education.