New federal and state initiatives have upped the ante for managed care organizations. Integrated models of care delivery for both acute and long-term services and supports are now eligible for financial rewards. With these incentives, managed care organizations are taking a hard look at how they can integrate services to improve health outcomes for members with disabilities…but they struggle to do it alone.
Pharmacy: We administer medication therapy management and star rating enhancement programs for health plans targeting members with multiple medical issues, such as the elderly and disabled. Our member reach rate is above 50% — exceeding industry benchmarks.
Member Outreach: We provide contact center services for health plans targeting public programs, including new member welcome calls, health risk assessments, medication adherence outreach, and member satisfaction surveys — in 19 languages.
State Medicaid Strategy Consultation: We develop public program strategy for managed care organizations, from procurement response to program development, and support and guidance on regulatory frameworks.
Complex Clinical Case Consultation: We develop person-centered approaches to reduce service utilization and leverage other non-health plan funded services.
Quality Management System Development: We develop systems to continuously monitor and improve quality in managed care service delivery, health, and safety.