Clinical Collaboration

Working together to provide seamless care

National Alliance has been developing and administering custom arrangements for hospitals, provider organizations and complex health systems since 2003. This specialized experience allows us to better understand our clients’ priorities and concerns. No matter what, keeping people healthy is the top priority. National Alliance is here to help by minimizing administrative burden, achieving more with internal resources, navigating the complexities of being both a system and provider and staying on the leading edge of innovative technology.

We collaborate with our clients and their clinical teams to support member health needs, drive domestic program utilization, and advance internal health initiatives. We accomplish this through configurable clinical processing, dynamic clinical program exchange and direct clinical partnership.

Configurable Clinical Processing

The flexibility of our clinical processing system allows clients to customize the handling of pre-certification, utilization management and case management activities for treatment at their own facilities. We can also customize covered benefits at in-house facilities versus external facilities. For example, we can create a custom setting to not require pre-certifications at domestic facilities so that members find it easier and more desirable to stay within the client’s network. Custom processing can also help transfer members back into the domestic network when they visit out-of-network facilities.

Dynamic Clinical Program Exchange

With an expert care management team, we leverage our proprietary care management and chronic condition programs to connect members with domestic programs, increase utilization and provide bi-directional data exchange and program referrals. This multi-disciplinary clinical team includes specialists in NICU, maternity, social work and behavioral health. Our best-in-class care management system houses data from all sources, including pre-certifications, claims, gaps in care, pharmacy and social determinants of health. This data is available via on-demand dashboards to enable quick, impactful interventions that create value for members and clients. We use predictive modeling to identify members who may be at risk for future high dollar claims or clinical complexity. This breadth of data, including outreach activities, is the ultimate collaboration on member management and benefits strategy.

Direct Clinical Partnership

When it comes to member care, our goal is to complement a client’s domestically provided services and provide support and insight to the health system. We partner with health systems’ clinical leadership via clinical strategy meetings, calls to discuss high-cost claimants and clinical case reviews. Our weekly and quarterly clinical rounds are an opportunity for coordination and enhancement of service. We also collaborate with clinical teams to promote internal initiatives. For example, if a client has an onsite nurse, we will work with them to co-manage members to boost program engagement. If the client has a condition-specific initiative, such as a program for diabetes, our clinical team collaborates to support the program’s clinical team.

process guide

Other Value-Added Solutions for Health Systems

We know the well-being of employees is essential to ongoing operations. To support and help promote in-house well-being programs, we offer an engaging digital wellness platform with integrated incentive management. Strive, powered by Virgin Pulse, features multiple member engagement options that integrate seamlessly with our programs. We even take it one step further by offering well-being coordinators to collaborate with a client’s in-house wellness team to create onsite programs. The flexibility of the National Alliance platform allows us to leverage our care management and chronic condition programs in concert with existing resources. From internal services to preferred vendors, we find a way to make the member and provider experience seamless.

Your Partner in Delivering Quality Care

Having worked with health systems for more than 20 years, we’re experts in navigating (and solving) the highest levels of complexity. Every day, we work hand in hand with health systems to help create the best possible outcomes. We leverage internal assets and third-party vendor relationships, custom-build programs around specific needs and provide continuous strategic support at every level. Contact us today to learn more about how we can custom-fit a solution for your health system.


More Insights

Get so much more than a TPA.

Reach out to learn more about the power of National Alliance.