health integrated overview brochure

Solutions OverviewPrecision Empowered Care Management™

Overcome these Challenges with Health Integrated and Precision Empowered Care ManagementHealth plan CXOs are grappling with the unprecedented challenge of delivering

a strong P/L while scaling for growth, serving the newly insured, meeting

regulatory shifts and managing unsustainable rates of chronic illness. Plans need

expert partners in quality, compliance and financial optimization.

Our unique approach uses actionable big data and proven biopsychosocial

interventions to precisely target and empower your most vulnerable and costly

members. When we uncover and address hidden drivers of high medical costs

and low quality, we strengthen your plan’s performance.

Health Plans Face Numerous Challenges

80%

of health issues are impacted by behavioral and social factors

60%

of health care plans earn fewer than four Stars from CMS

50%

of health care costs are caused by just 5% of the population

The Health Integrated Difference

Health Integrated leads the industry with Precision Empowered Care Management, enabling health plans to precisely manage their most vulnerable members. By combining actionable big data with a proven biopsychosocial model, we address the physical, psychological and social drivers impacting member health and satisfaction. As a result, plans enhance quality, achieve compliance and strengthen their financial performance, while empowering members to achieve better outcomes.

CAREMANAGEMENT

DATAANALYTICS

PRECISIONEMPOWERED

Multichronic Care Management Engaging members with multiple chronic conditions impacted by underlying behavioral and social factors requires a highly personalized approach. They are often the “missed members” who do not respond to traditional care management. By targeting and managing these members with our unique therapeutic model, they improve self-efficacy and compliance resulting in lower medical costs and higher quality measures.

Dual Eligible Special Needs Plan (D-SNP) Model of Care Our turnkey solution is designed to meet the rigorous care delivery, quality and compliance imperatives for care coordination for dual eligible populations. We manage the complexity of care with automated workflows and mandated tools. These include everything from health risk assessments to transitions in care, with the focus squarely on member needs while ensuring full regulatory compliance.

Case Management – Medical and Behavioral A member’s medical crisis or serious behavioral health condition can significantly impact health plan utilization. Our integrated approach accounts for the physical, behavioral and social issues that may complicate these situations and further escalate costs. Combined with our expert care coordination, your plan will control expenses while your members experience improved outcomes.

Utilization Management – Medical and Behavioral Our solution safeguards against unnecessary medical expenditures by closely monitoring appropriate use of services and providers. With our approach, members receive the right care, at the right time, in the right setting. Our highly flexible solution can be configured to meet your plan’s needs, whether you need a full suite of utilization management services or specific components to fill in gaps.

Total Care Partnership For health plans outsourcing their medical management functions, our comprehensive solution provides a true partnership with risk-sharing. Our model incorporates centralized care coordination with the integration of programs, technologies and workflows for optimal efficiencies. Combined with care management expertise and data capabilities, partners receive the greatest return on investment in quality, compliance and savings.

Ancillary Services We offer several care management services that meet the specific needs of health plans and their members.

` Transitions in Care – prevents readmissions with expert planning, communication and care coordination

` Disease Management – Effective tools for members with modifiable chronic illnesses to lead healthier lifestyles

` Health Appraisal – compatible with multiple lines of business and compliant with NCQA standards

` Crisis Line – averts unnecessary hospitalizations and addresses the unique safety issues associated with behavioral health, 24/7/365

Professional Services and Consulting Our experienced clinical, quality, data and operational professionals work with health plans to develop strategies to help them thrive in today’s challenging market. Our unique combination of care management expertise and data analytics allows us to not only identify opportunities, but also to implement the improvements to enhance performance.

Our Solutions

Empower your plan’s performance with a data-enabled care management solution that truly coordinates care and yields results.

ENHANCE QUALITY ANDIMPROVE RATINGS

ACHIEVE COMPLIANCEAND ACCREDITATION

INCREASE SAVINGS ANDOPTIMIZE REVENUE

health integrated overview brochure

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