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.

HQP is a proven independent provider of program evaluation and outcomes verification services to healthcare organizations. Our unique data analytics solution comprises a cloud-based data integration platform, rigorous comparative analytics processes, and professional services expertise required to help determine what really works in value-based care. HQP engages with healthcare organizations committed to value-based care that recognize the importance of independently validating outcomes of vendors, investments, and programs. HQP serves as a third party, independent partner to measure performance and outcomes of existing shared-risk programs and vendor relationships tied to value-based metrics. Our analyses help clients support investment decisions, vendor renewals, or payment allocations by leveraging our outcomes verification methodologies. Our outcomes verification services help organizations determine what really works without any marketing spin ranging from specific interventions to service-line operations, identification of gaps in population health programs and interventions, evaluations of vendor performance and impact, allocation of payments for risk-based contracts, and more. Our services help healthcare organizations produce measurable clinical, financial, and operational improvements through statistical and trustworthy analyses. We envision a future where all healthcare programs are designed as a whole-system and decisions are data informed.

Health Quality Partners (HQP) is a 501(c)(3) non-profit R&D organization committed to designing, testing, and disseminating more effective systems of care for vulnerable patients. HQP's unique design and system thinking approach has proven to reduce suffering, improve health outcomes, and can lower the overall cost of health care. This has already been convincingly demonstrated among higher risk chronically ill older adults. As tested within the Medicare Coordinated Care Demonstration and with Aetna, HQP’s model of Community-based Advanced Preventive Care, significantly reduced hospitalizations, deaths, and total Part A & B Medicare expenditures.