Specialized Services

Delivering solutions through Member Engagement and Health Information Management services for health plan networks nationwide.

Backed by decades of experience working with health plans of all sizes, our team possesses a profound understanding of the challenges faced by your business. We are committed to assisting you in achieving your goals with unwavering determination.

We have contracts with regional, local, and special needs plans, serving a diverse range of members, including Medicare Advantage, Medicaid Managed Long-Term Care, and Dual-Eligibles. Additionally, we cater to Managed Medicaid, Commercial ACA, and General Commercial Populations. As an ACAP-endorsed organization, we extend our assessment and care management services across the United States, including Puerto Rico.

Member Engagement

In-home health risk assessments and annual wellness visits performed either in person or virtually. As part of this service, our team can also perform health screenings, support vaccine adherence, provide continuity of care, and conduct CAHPS surveys. This solution can also include over-the-phone outreach coordination.

Health Information Management

Medical record retrieval for retrospective risk score accuracy and HEDIS® reporting, conducted by experienced medical coders. Your organization can choose the collection method that works best for you, such as clinical data extraction, remote EHR access, onsite data collection, and record requests.

Comprehensive Member Engagement

An end-to-end member encounter solution, delivered by industry experts

Designed in accordance with CMS guidance and best practices, our Member Engagement services are intended to be an integral component of members’ continuity of care.

This service covers all the key details of member outreach, from encounter facilitation to in-home assessments, health screenings, and virtual health visits. We help health plans large and small identify members who need in-home assessments, then partner to deliver the appropriate care.

Leveraging industry-leading technology, our team of nurses and care coordinators take care of every step of the in-home assessment for you, from targeting patients and scrubbing lists to scheduling appointments and collecting data.

Our goal in each encounter is the same: To build patient relationships that keep members actively engaged in improving their overall health. We do this via three main services.

Encounter Facilitation

Our platform offers a range of features, including personalized member letters featuring your health plan’s branding, which encourage patients to follow up with their Primary Care Provider (PCP). To ensure seamless coordination, trained agents from our CCS call center make follow-up phone calls, connecting patients with their PCP to assist in scheduling appointments. Additionally, we streamline the process by sending relevant documentation to the PCP, containing specific information about the patient’s risk factors and/or quality gaps.

Supplemental Member Encounters

Additional modules available with our Member Engagement services include Health Screenings, Virtual Health Visits, and TestSuite Solutions.

In-Home Assessments (IHA)

CCS performs a 60-minute, multi-modal member encounter in the comfort of the member’s home, overcoming utilization obstacles and barriers to care. The primary objective of the IHA is to complete a comprehensive evaluation of a member’s health resulting in the closure of any documentation gaps for quality and risk adjustment. In accordance with both good practice standards and CMS guidance, the IHA is intended to be an integral part for the member’s continuity of care.

This module is made up of five key components:

Data Output
Data Transfer
Member Engagement
Point-of-Care
Coding & Abstraction

During the point-of-care component, the provider performs a historical and physical exam, leveraging guided encounter* and documentation support to improve quality outcomes, risk score accuracy, patient and provider engagement, and patient retention.

*Guided encounters are made possible by our partnership with Inovalon, a provider of industry-leading SaaS solutions. Their Converged Patient Assessment software informs our in-home assessments.

Virtual Health Visits (VHV)

CCS collaborates with Inovalon to conduct virtual encounters using their Converged Patient Assessment solution, providing almost all the advantages of an In-Home Assessment. The processes and forms are highly similar, ensuring a seamless transition. Moreover, if the member has access to a scale and a blood pressure cuff, nurse practitioners can even record vital readings. Although the capacity for a comprehensive physical examination is limited, nurses can request patients to position their cameras for a visual examination.

By offering members the flexibility to choose between In-Home Assessments and Virtual Health Visits, we enhance the likelihood of achieving higher completion rates for your plan. This approach broadens the options available to patients, maximizing their engagement and overall satisfaction.

TestSuite Solutions

CCS performs or facilitates the following general screening and testing services for members with the appropriate indicated quality gap(s):

Bone Mineral Density Scan
Diabetic Retinal Exam
Fecal Immunochemical Test (FIT)
Hemoglobin A1c
Kidney Evaluation for Patients with Diabetes (KED)
Peripheral Artery Disease (PAD) testing
Spirometry

Improve your member targeting and engagement efforts to deliver better care results, with greater efficiency. Discover our Member Engagement solutions.