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.
