Improving Health Outcomes

Client: AmeriChoice Health Plans (NY, NJ, MA)

Summary


AmeriChoice Health plans have approximately 133,000 Medicaid and Medicare members, many of whom are racial/ethnic minorities. As part of its growth plan, management had a three-fold objective:

  • Decrease customer attrition through the development of targeted programming
  • Decrease medical expenses due to misuse of health services
  • Integrate member related information between payor and provider to improve service

Process


M. Davis and Company, Inc. designed and administered a health assessment survey to provide information needed to create the foundation for future planning. The survey was administered to over 25,000 members, during a fifteen-month period, via Computer Assisted Telephone Interviewing. Interviews were conducted in English, Spanish and Russian. The survey/assessment was a “proprietary” design and MDAC developed all necessary computer programming and processes for the Health Assessment Data Management System and provided the client with online, real-time access to both the data and a dashboard of reports

Results


The following results were achieved:

  • Compliance with mandatory reporting requirements
  • Preliminary snapshot of the health and financial risks of new customer populations
  • Development of the historical baseline for negotiating capitation rates
  • Reduced the health plan’s financial exposure by initiating better management of high risk health plan members identified during the survey process

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