The Client

A regional health system, consisting of a Medicaid plan, hospitals and a hospital-owned physician network, needing to improve the quality of care while reducing costs through innovative engagement and prioritization programs. EXL partnered with a third party and the health system to win a CMS grant to fund this program.

Client’s Challenges

  • Quantify the risk of the entire Medicaid plan population
  • Define & prioritize conditions – both medical and behavioral for management
  • Develop an effective engagement process tied to member characteristics
  • Optimize & align the plan’s internal resources (call center, wellness coaches, disease and case management programs) against the whole population needs
  • Build the ability to track the program for quality improvements

EXL’s Solutions

  • Developed an integrated data warehouse in 8 weeks
  • Created member profiles with demographics, current and prospective risk scores
  • Identified/prioritized conditions such as maternity, premature babies, asthma, diabetes and depression as key risk drivers
  • Helped develop actionable interventions mitigating those conditions above
  • Collaborated with a third-party engagement group to drive member communications and engagement process
  • Monitored/tracked activities and reported on outcomes and ROI

Value Proposition

  • Helped the client deliver 15% improvement in quality measure compliance
  • Enabled client to realize $1.5M+ savings from a customized maternity program
    • The plan is now sharing the best practices with providers
  • Helped increase nurse productivity by focusing care management efforts on emerging high risk patients
  • Expedited/improved identification & prioritization as well as the reporting process
  • Provided the client with advanced analytics capabilities

RESULTS

Provide advanced analytics and reporting to enable health plan and hospitals and providers to improve quality and outcomes collaboratively


Written by EXL Health Team

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