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.
We work with managed care organizations to ensure members with complex health issues receive the high-quality, cost effective care they need to live their best lives. Our multidisciplinary team includes health data analysts, experts in health care policy, finance and law, former state program officials and regulators, and clinicians to support every development stage of managed care product models in an increasingly competitive environment. Our innovative, results-driven solutions include:
- 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.
- Managed Long-Term Services and Supports: We offer the following:
- Gap analysis of core capabilities and health plan infrastructure
- LTSS data management, reporting, and analytics
- LTSS utilization management, including prior authorization and complex case management
- LTSS network development
- Supported employment
- Behavioral health integration
- Plan and provider staff training
- Comprehensive program evaluation
- Quality Management System Development: We develop systems to continuously monitor and improve quality in managed care service delivery, health, and safety.