The Care Assist Program (CAP) offers a comprehensive and proactive patient centered approach to a patient’s outpatient surgery experience with transitional care assistance before and after an elective, outpatient procedure. A patient’s engagement with the CAP program ensures the pre surgical needs of the patient are met and optimal utilization of the patient’s contracted provider and surgical facility network is achieved creating a better healthcare experience for both the patient and health plan. The Care Assist Program (CAP) program aims to ensure that patients are following outpatient treatment plans including appointments, medications and other services which ultimately results in fewer overall complications, a better quality of life for both the patient (and their support system) and a faster return to work for employed individuals.

Innovative Healthcare Delivery (IHD) improves quality outcomes and reduces costs for health plans, hospitals, corporate employers and self-insured clients utilizing a high touch, patient centric non-clinical approach. We specialize in simplifying and personalizing the healthcare experience for every patient, every time. We identify Social Determinants of Health barriers and address them in a meaningful way to improve quality of life and medical outcomes while creating a better patient experience. Our organization is committed to the effective delivery of programs that assist Employer Groups, Self Funded Plans, Fully Insured Plans, State and Federal Plans and Hospitals. Our programs are designed to complement existing resources available in the market and foster a comprehensive approach to patient care through a cohesive delivery system. The end result is a patient base that is engaged, educated and empowered to make better healthcare decisions.

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.