Health Care Services at SRMCS

Many disease management programs work exclusively with the chronically ill, which represents 10 to 20 percent of the population. Wellness and prevention programs address the other 60 to 80 percent and facilitate health promotion and disease prevention across the entire population.

Preventive & Wellness

SUNRISE MEDICORP SOLUTION (SRMCS) Healthcare offers a comprehensive suite of tools and resources that provide tailored communication addressing lifestyle issues and behavior change. Resources include, but are not limited to:

  • Lifestyle management programs, including programs for weight management, smoking cessation and stress management, with email reminders and newsletters
  • Tailored wellness programs and Diet and fitness planning

Behavioral Healthcare

Individuals with mental illness – particularly those with accompanying medical conditions – often struggle with maintaining the care required to be healthy. Preventive care, follow-through and coordinating information from multiple providers are a challenge. When unmet, the result is inappropriate care and a reliance on high-cost emergency facilities.

Effective behavioral health solutions ensure appropriate, high-quality care; integrate medical and behavioral health needs; ease administrative burden; and provide prevention and early intervention. Focused on working with providers, state agencies, and community resources to support individuals in improving their quality of life.

With our roots in behavioral health, SUNRISE MEDICORP SOLUTION (SRMCS)has a firm understanding of the complex treatment needs and diversity of individuals with mental illness. Our services recognize the whole person and promote consumer and family driven care.

  • Child welfare socially necessary services
  • Provider education, audits and technical assistance
  • Developmental disability waiver budgetary model
  • Onsite inspection of care compliance and quality audits
  • Specialized program for persons with serious mental illness
  • Administrative services
  • Utilization review
  • Medical necessity reviews
  • Care coordination
  • Substance abuse services

Utilization Management

Eliminate Inappropriate Care – Improve Clinical and Financial Outcomes . To deliver the best care possible to members and to use healthcare most effectively, it is critical to ensure that the care being delivered is:

  • Medically necessary
  • Appropriate
  • Aligned with clinical best practices
  • Suboptimal healthcare services can compromise members’ health and waste limited resources.
  • Specialized program for persons with serious mental illness

Focused on identifying and removing unnecessary and redundant care, and promoting clinical best practice, SUNRISE MEDICORP SOLUTION (SRMCS)Utilization Management and Review services leverage our deep experience and clinical foundation to fully understand your healthcare delivery systems and processes to recommend and implement services that will work with your systems, facilities, and providers.

  • Prior authorization and preadmission certification
  • Concurrent review
  • Retrospective review
  • Focused reviews
  • Discharge planning and reporting
  • High-risk care coordination

Health Intelligence & Consulting

SUNRISE MEDICORP SOLUTION (SRMCS)Healthcare maintains a dedicated Health Intelligence (HI) team which provides analytic services to support both corporate level initiatives and account level operations. This unit is responsible for measurement definition, quantitative analysis for product and business development and conducting evaluations and studies on healthcare programs. Maintaining these functions in-house allows us to evaluate programs and effectively bring insights through customized analyses and reports that are timely, tailored, and meaningful.

SRMCS experts not only perform analyses and evaluations, we also offer comprehensive findings, practical recommendations, and effective solutions. Our services are tailored to meet the requests of every customer, project, and program.

SRMCS External Consulting unit, staffed with both clinical and analytical professionals, specializes in delivering a full continuum of services necessary to improve outcomes. We focus on program and policy development, evaluation and implementation; decision support and quality assurance services; data analysis and reporting; survey

  • Healthcare Data Analytic and Statistical Services
  • Performance Measurement and Quality Assurance Services
  • Member Identification, Predictive Modeling and Risk Stratification
  • Survey Development and Administration
  • Program Evaluation Design and Implementation
  • Analysis of Administrative Data