Extend your care team without adding to your headcount.
Healthcare Utilizations provides outsourced and collaborative chronic care management and care coordination support for physician practices, medical groups, MSOs, and value-based care organizations - working quietly behind the scenes as an extension of your team.
Built for organizations accountable for outcomes and cost - designed to strengthen care between visits, deepen patient engagement, and support your value-based care performance.
The gap between visits is where margin leaks
In value-based and capitated care you are paid to manage the whole member - but there is no dedicated layer watching your high-risk members between visits.
Your PCPs are capitated and full
Physicians are paid for what happens in the exam room. Longitudinal, between-visit oversight of high-risk members is unpaid time they do not have.
Chronic care management is underused
Structured chronic care management is one of the most underused tools in Medicare - and one payers already recognize - yet it is left on the table by most organizations.
A high-risk few drive most of the cost
A small share of members generates most avoidable ER and inpatient spend. When no one owns them day to day, that is where margin bleeds.
We are that layer - a clinical and operational team that plugs in underneath your PCPs, and extends them without replacing them.
Where margin leaks out between visits
Every one of these is a gap between visits - the exact space a dedicated care-management layer is built to close.
Avoidable ER use
The member who skips the office and heads straight to the ER. A single stay can erase a year of margin.
Admissions & readmissions
Conditions that escalate to inpatient, and 30-day bounce-backs that a timely call could have caught.
Uncontrolled chronic conditions
Diabetes, CHF and COPD drifting out of control between appointments, with no one watching the trend line.
Referral & authorization leakage
Specialists expanding scope beyond an evaluation, and services rendered outside the gatekeeper that land back on you.
Medication problems
Non-adherence, duplication and gaps that quietly drive ER visits and admissions.
Fragmented follow-up
No structured post-discharge contact, missed PCP follow-ups, and referrals that never close the loop.
Built for the organizations accountable for care
We support teams that carry clinical and financial responsibility for their attributed patient populations.
Management services organizations
Add scalable care-management capacity across your affiliated practices without building it in-house.
Primary care physicians
Keep patients supported between visits while your clinicians stay focused on the exam room.
Medical groups
Standardize chronic care management and coordination across sites and providers.
Independent physician practices
Offer robust care management without the overhead of a dedicated internal team.
Value-based care organizations
Reinforce the between-visit engagement that value-based performance depends on.
Medicare Advantage & risk-bearing networks
Support attributed and capitated populations with consistent, documented outreach.
Care management support, handled with your patients in mind
A structured clinical layer that extends your PCPs - it does not replace them. Every clinical concern escalates to your physician.
- Risk stratification and high-risk member identification
- Member outreach, enrollment and engagement
- Comprehensive care plans, built and maintained
- Monthly telephonic and digital contact
- Medication reconciliation and adherence support
- Post-discharge and ER follow-up (transitional care)
- Appointment and specialist-referral coordination
- Care-gap and preventive-care outreach
- Social-needs screening and referral
- Escalation of clinical concerns to the PCP
- After-hours routing and support
- Documentation delivered to the PCP or your system
The value isn't monthly phone calls. It's earlier problem detection, redirected avoidable utilization, and a defensible audit trail on every member.
How we work with you
A collaborative model that fits into your existing operations, not around them.
Understand your goals
We start with your patient population, your care-management priorities, and the outcomes and metrics your organization is accountable for.
Design the program together
We agree on scope, workflows, and how we fit alongside your clinicians - all governed by a written services agreement.
Engage your patients
Acting under your direction, we deliver consistent outreach and coordination for your attributed patients, documented as we go.
Report and refine
You receive clear documentation of the work performed, and we adjust together as your needs and populations change.
Two ways to run it, matched to how you're paid
We match the engagement model to how your organization is reimbursed - as your capitated care-management partner, or as a way to open a new Part B revenue stream.
Part C, Medicare Advantage
- Delivered as a care-management service, billed to your organization on a per-member, per-month basis.
- No CCM claim and no 20-minute billing threshold to manage.
- Built to protect the capitated margin through fewer avoidable ER visits and admissions.
- We manage the work; your PCPs stay the clinicians of record.
- Dashboards evidence engagement and utilization impact.
Part B, Original Medicare
- Bill Medicare directly for chronic care management (CPT 99490 and add-on codes).
- Requires 20+ documented minutes per member per month.
- Fully audit-ready through minute-level time tracking.
- Creates a new reimbursement stream, not just cost avoidance.
- We run the time tracking, documentation and claim-ready export.
What one avoided event costs
National benchmarks - apply them to your own ED volume and your highest-risk members.
Care that could safely happen in a lower-cost setting.
What proactive care management is built to help prevent. Older, sicker members run higher.
Yet about 2 in 3 Medicare members live with two or more chronic conditions. The opportunity is wide open.
Sources: CMS Medicare inpatient payments (average admission cost); CMS Chronic Conditions Charts (share of beneficiaries with two or more conditions); care-management uptake from CMS-claims analyses (Avalere Health); ER visit cost and avoidable share from the Health Care Cost Institute and Premier Inc. These are national benchmarks, not a savings guarantee - actual results depend on your population and program design.
What partnering with us is designed to do
We work quietly behind the scenes so your clinicians can focus on care. Partnering with us is designed to:
Strengthen care management
Add consistent, documented care-management capacity across your patient population.
Improve patient engagement
Keep patients connected to their care plan and their practice between visits.
Reduce avoidable utilization
Support timely, proactive follow-up intended to help patients avoid preventable escalations.
Protect value-based revenue
Reinforce the engagement and documentation that value-based care performance depends on.
Outcomes depend on many factors, including your patient population and program design. We do not guarantee specific clinical, financial, or performance results.
The platform behind it
Purpose-built software for care management - not a repurposed EHR.
Care-plan engine
Every member's plan built, versioned and maintained in one place.
Minute-level time tracking
Audit-ready logs that stand behind Part B billing.
ADT & utilization alerts
Admission, discharge and transfer feeds surface events in real time.
Risk stratification
Ranks the high-risk few who drive most avoidable cost.
MSO & PCP dashboards
Engagement, utilization and financial-performance views by panel.
Documentation exports
Notes flow to the PCP or your system, with a full audit trail retained.
Build it in-house, or bring us on
Doing this internally means pulling your existing staff off the work that keeps your practices running.
Build it in-house
- Front-office and clinical staff pulled off revenue work - every hour on care management is an hour off the patients in front of them.
- Hire, train and supervise certified case managers you do not have today.
- Build or license care-plan and time-tracking software from scratch.
- Own the audit risk if the documentation is not defensible.
- Carry fixed payroll whether members engage or not.
Bring us on
- A turnkey team of certified case managers, ready on day one.
- Your staff stay focused on the work that keeps your practices running.
- A purpose-built, audit-ready platform - care plans and minute-level time tracking - already in place.
- A team with 20+ years across utilization management, quality, compliance and value-based care.
- Variable cost that scales with the members actually managed - and we carry the documentation and compliance burden.
An extension of your team - not a replacement for it
Healthcare Utilizations is a care-management support partner. We are not the patient's primary medical provider, and we do not step into your clinical relationships. We work under your direction to carry the operational weight of care management and coordination.
When our work involves your patients' protected health information, we act as your business associate under HIPAA and handle that information only on your behalf, under a Business Associate Agreement.
- Works under your direction
- Collaborative, not disruptive
- Documented and transparent
- HIPAA business-associate model
Let's talk about your patient population
Tell us a little about your organization and we will follow up to explore whether we are a fit.
Thank you - your request has been received.
A member of our team will review your message and follow up within one business day. If you would like to speak with us sooner, call 844-799-4267.
Prefer to talk now?
Email: admin@healthcareutilization.com
Healthcare Utilization Consultants LLC
7901 4th St N, STE 300
St. Petersburg, FL 33702
We partner with healthcare organizations to support their patients, so we are not able to provide care to patients directly. If you are a patient, your own provider's office is the best place to start.