Core Services

At IHIS Health we are committed to serving clients in all sectors of the health care industry. We provide health outcome research and evaluation services; data analysis and other software services; regulatory and policy-related services; and auditing, compliance, and contract review services. Strong relationships are maintained in government, academic, and private sectors of health care to facilitate our client goals.


Care and Utilization Management Services

Institute for Innovation Healthcare Strategies’ personnel have extensive experience in providing consulting, data analysis and clinical services for utilization review/case management in both Medicaid and commercial fee for service and managed care programs. IHIS Health provides the services of licensed pharmacists and professional staff with extensive experience in clinical and economic evaluations to meet the requirements of the contract. IHIS Health also provides evaluation and assessment regarding the quality of care participants receive as a result of drug therapies based on treatment guidelines and best practices and other clinical intervention and educational support provided for enhancing clinical outcomes.

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Analytical Services

IHIS conducts prescription utilization, medical utilization and cost analyses for Medicaid programs and health plans throughout the country. Intelligent analytics are applied to claims data using proprietary algorithms that identify aberrant patterns of care and utilization. Based on this, IHIS can identify and target patients exhibiting uncoordinated care patterns using claims data for care/disease management intervention programs and medical homes to achieve cost savings and improved outcomes.

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Regulatory and Policy-Related Services

IHIS Health's regulatory and policy-related services include but are not limited to reviewing and designing health plan fraud policies, programs, and claims edits, consulting on health care reform policies and inititiatives at the state and federal level, health information technology and policy, pharmaceutical benefit analysis and design, and formulary/PDL program and policy evaluation. 

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Auditing, Compliance, and Contract Services

Institute for Innovation Healthcare Strategies offers support in the areas of medical and pharmacy claims auditing, pharmacy purchase, inventory, and billing reconciliation audits, developing internal audit procedures and quality assurance measures, and third party claims auditing and compliance reviews. 

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