Blog
5 Ways Case Managers Can Support High-Risk Populations
According to the Centers for Disease Control and Prevention, six in ten American adults live with at least one chronic disease, and four in ten live with two or more, leaving health plan members with high-risk conditions to compete for resources to support their care needs.
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Articles
Doug Johnson Joins Clearlink Partners as Executive Vice President, Emerging Markets
Doug brings nearly two decades of industry experience. He spent the last fourteen years at Anthem, now known as Elevance Health, serving the government business in a variety of leadership positions across Medicaid and Medicare.
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Case Studies
Complex Product Design & Delivery
The health plan division of an integrated care delivery system develops and manages government and employer programs to serve more than 400,000 members. The organization sought to expand its product offerings and introduce a Dual Special Needs Plan (D-SNP) in the state.
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Case Studies
Enhanced Utilization Review
A public, not-for-profit Medicaid HMO plan sought help conducting an end-to-end assessment of its utilization management (UM) department to improve the effectiveness and efficiency of its operations. With an outdated medical management system and no clear method of determining productivity success, meeting compliance requirements, and following quality measures, the health plan needed support in adopting reporting tools, aligning processes, and upgrading technology solutions.
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Case Studies
Prepared Population Health Management
A regional health plan was challenged by its board to adapt a community-based, neighborhood model to care for more complex, high-need, high-utilization, underserved populations, including ABD, LTSS, LTC, SMI, and IDD members as well as dual eligibles and foster children. The health plan needed to successfully demonstrate its ability to identify and manage risk, coordinate care, ensure access, deliver outcomes, and decrease costs for various member cohorts.
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Case Studies
Compliant Case Management
A community-based care delivery organization holds a new delegation contract with a regional health plan to provide case management services for Special Needs Plan (SNP) members. In order to receive an additional assigned cohort of Severely Mentally Ill (SMI) members, the care delivery organization needed to demonstrate its ability to transition members incompliance with all NCQA standards, state regulations, and contractual requirements.
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