Government Healthcare Administration

Explore Our Impact in Medicaid & Medicare Advantage

• Engage Members

  Ensuring that members get the right care at the right time in the right place is our priority. Our teams work together to emphasize the importance of prevention, provide follow-up reminders, and help remove barriers to care such as language and transportation. We keep members with special healthcare needs (SHCN) top of mind, including people with comorbid conditions such as pregnancy and diabetes.

  One example is in the Medicaid dental contract we manage for the State of California.

  In our California Medicaid dental market, we wanted to improve preventive visits among some of our members with special health care needs. We used automated bilingual calls to reach parents and guardians of Medicaid members who had not visited the dentist recently, according to our records. During this call, the parent or guardian was given the option to receive live, bilingual help with making an appointment. Our results showed that those who take advantage of the live appointment assistance were more likely to make—and keep— their child’s dental appointment within three months. This increase was seen for children of all ages—from newborn to age 20.
• Satisfy Providers

  In order to help achieve your goals for member access, we need a stable and satisfied network. Our provider-centric, local network management model puts providers in the hands of our experienced clinical leaders. We also offer peer-to-peer consultation with trained, licensed clinicians and office support delivered by provider relations professionals with real-world clinical and office experience.

  One example is in the Medicaid dental contract we manage for the State of Utah.

  In 2017, an analysis of our Utah Medicaid/CHIP prior authorization data revealed that the scoring of the required orthodontic index was inconsistent among providers. We engaged in provider outreach with  several rounds of phone calls and emails, and  brought the Clinical Director of Utilization Management, to Utah for two in-person presentations  on index scoring and claims submissions. Providers were then encouraged to participate in the Q&A sessions that followed, allowing participants hands-on experience with the scoring process before the meeting ended. The result was an improvement in prior authorization submissions, which helped increase provider satisfaction and reduced delays in the onset of treatment.
• Reduce Costs

  Healthcare costs continue to rise, putting more pressure on our state and health plan clients to be good stewards of the taxpayer dollars that support Medicaid and Medicare. We’re here to help by emphasizing the value of preventive care; reducing fraud, waste, and abuse; and carefully managing high-cost services.

  One example is in our Georgia Medicaid market.

  Our IV Sedation program provides the option to move dental patients out of the hospital or ambulatory surgical center for surgical procedures and returns them to their communities for lower cost treatment through mobile sedation services arranged in a dental practice setting . In our Georgia Medicaid market, over a three-month period in 2019, 708 dental procedures were arranged out of the hospital and into a dental office setting , saving our health plan clients an average of $6,889 per visit or $4.9M in all.
• Overall Health

  Dental and eye care are important and only address a small part of the body. We help by integrating our clinical management programs with other disease management and health improvement efforts, like assisting our health plan partners in diagnosing and managing diabetes and reducing opioid prescription rates. 

  One example is in our Kentucky Medicaid market.

  In our Kentucky Medicaid dental market, where we manage dental benefits for 80 percent of the market, our prescribing program reduced the number of  dentists writing opioid prescriptions at rates that exceed the state’s recommended guidelines. In just six months, we reduced the number of high prescribers by 70 percent.