ComplexCare Solutions helps extend the reach of health plans and other payers into their members’ homes with high-touch, high-value programs that deliver superior outcomes. From assessment through care management, our face-to-face engagement results in a more holistic approach to minimizing risk and fostering wellness.
Our assessments examine clinical, behavioral, environmental and social determinants of health. Our care management programs use lower-cost, community resources to avoid the need for higher-cost facility-based services. We provide specific recommendations for closing care gaps, especially those that can be readily closed such as fall prevention, medication reconciliation and nutrition assistance. And our multi-disciplinary care teams help members stay on course and achieve a greater level of independence. In fact, most of the members we service “graduate” back to self-care within 4-6 months.
We understand that proper membership selection is critical to ensure a successful program and good return on investment. So, we also offer a proprietary process for identifying members who are most impactable. Using a combination of proprietary algorithms to analyze claims data and a host of non-traditional assessment information, we can identify members who have both the will and the need to benefit from home-based interventions while avoiding members who are already under care or unlikely to respond.
Our modular suite of services is designed to integrate with your operations to build a customized solution. In every case, we provide ongoing analysis and reporting to measure program performance, while ensuring strict compliance with CMS, state and NCQA regulations.
Our programs are proven to work.
Assessment results:
- Greater than 98% coding accuracy
- Appropriate reimbursements
- An average ROI of 6+:1 for assessments
Care management results:
- Improved member compliance and independence
- Lower costs from reduced medical expenses, readmissions and ER visits
- 94% member satisfaction
