Supporting At-Risk Members: Encouraging healthy living to facilitate wellness and simultaneously ensuring members have timely access to appropriate, quality care is essential to both your mission and success. This two-pronged approach helps manage costs, improve health/outcomes, and drive member satisfaction, loyalty, and retention. Of course, your members live in a multitude of environments and have varying levels of support and resources. Research shows ‘social determinants’ —circumstances and conditions in which people are born, grow up, play, live, and work — correlate with members’ ability to stay healthy, engage in preventive screenings, and access care. Understanding these correlations and addressing disparities is the key to helping at-risk members stay healthy and access the care they need. New Medicaid Rules: Federal rules governing Medicaid managed care now allow health plans to spend capitation dollars on value-added services not covered by the state to improve quality and/or reduce costs. While the cost of the services can’t be included in capitation rates, they can be included in the numerator of the medical loss ratio (MLR) if they’re part of a quality initiative. This policy shift emphasizes the importance of proactive outreach to members who need assistance obtaining services which support their mental, physical, and emotional well-being. Hierarchy of Needs: Wellness, healthcare, and social determinants are inextricably intertwined. Research shows 40% of health outcomes are attributable to social and economic factors, reflecting a stronger correlation than the link between health outcomes and genetics, health behavior, clinical care, or physical environment3. As an example: every year 63% of low-income households and older adults must make spending choices between food and medical care4. To engage your at-risk members in heathy behaviors and timely care, you must first help meet their most basic needs. Proactive Outreach: • Identifies members most in need of assistance • Provides a member-centric, concierge service with personal outreach via experienced, empathetic advocates • Leverages our robust database of thousands of private and public social programs • Assists members with determining program eligibility and enrollment • Confirms benefits are being received and maintains ongoing engagement Our Expertise and Experience: For over 17 years we have specialized in addressing social determinants of health (SDOH) by identifying barriers to care. With our time-tested engagement process, we assist members with eligibility identification and enrollment for dual status in Medicare/Medicaid as well as with annual recertification, Medicare Part D, and community programs.

Change Healthcare is inspiring a better healthcare system. We are a leading independent healthcare company that provides data and analytics-driven solutions to improve clinical, financial and patient engagement outcomes in the U.S. healthcare system. Our comprehensive suite of software, analytics, technology-enabled services and network solutions take costs out of the healthcare system by driving improved results in the complex workflows of payers and providers by enhancing clinical decision-making and simplifying billing, collection and payment processes, and enabling a better patient experience. We are creating a stronger and more efficient healthcare system that enables better patient care, choice, and outcomes at scale.

Innovaccer’s care management solution enables health systems to drive cost-effective, coordinated care with an integrated solution to unlock value for health plans, from care management to referrals to prior authorization. The patient-centered solution that connects every care journey touchpoints into personalized 1-to-1 health moments powered by 360-degree patient profiles and prospective patients inclusive of EMR, clinical, financial, SDoH, patient data for better care delivery. With predictive models, the solution can predict any health system’s total cost of care to a much higher degree of accuracy than industry standards for better management of resources. It also offers wide range of workflows that assists cares teams to simplify redundant tasks, bridging care and coding gaps, facilitating contextual, relevant, and dynamic bidirectional communication to deliver care outcomes. 

Innovaccer is a healthcare technology company that aims to revolutionize the way healthcare organizations collect, analyze, and leverage data to transform value-based, patient-centered, equitable care. Our mission is to connect and curate the world’s healthcare information to make it accessible and useful. The company provides a comprehensive suite of solutions that empower healthcare providers, payers, and life sciences companies to deliver efficient care and drive innovation in the industry. The Innovaccer platform unifies patient data across systems and care settings, empowering your organization to provide higher quality care to patients and populations, while reducing costs, improving experiences, and strengthening financial and operational performance. Innovaccer’s EHR-agnostic solutions have been deployed across more than 1,600 hospitals and clinics in the US, enabling care delivery transformation for more than 96,000 clinicians, and helping providers work collaboratively with payers and life sciences companies. Innovaccer has helped its customers unify health records for more than 54 million people and generate over $1 billion in cumulative cost savings.

An intelligent care management solution that empowers care teams to drive an outstanding care experience through Innovaccer’s unified patient record, comprehensive care platform with integrated workflows and advanced analytics. Care Management solution delivers actionable insights to care teams, helping them drive personalized and impactful care at every step of the patient journey. It also allows them to effectively prioritize clinical needs and care gaps while simultaneously tracking their performance to create best practices going forward. 

While most of our features and functionality are pre-built, we collaborate closely with each client during the negotiation and implementation phases of each project to customize reports, workflows, etc. to best meet each client’s needs, and are willing and able to adapt our roadmap and client-specific efforts to further adapt our integrated data model platform and integrated applications.

Innovaccer understands that value-based organizations require cohort-driven, strategy appropriate, and tactically relevant programs to drive provider and patient compliance. Innovaccer works together with the customer during the contracting and implementation phase to craft multiple programs that take client-specific needs into consideration, including the comprehensiveness and efficiency of cohort-specific evidence-based guidelines; benchmarking flexibility; and multiple risk model assignment.