Care Management Toolkit

NOTE: You must login to your Alliance account to access the articles and resources below. Some content may only be accessible to Alliance members.



Presentation: Case study - A medical home program powered by data
SelectHealth shares how they are incorporating pay-for-performance programs, provider engagement and chronic condition management approaches to support HCCs and quality gap in care closure. Presented at the Leveraging Analytics meeting in Fort Worth, Texas.


Presentation: What leveraging pop health, big data and social determinants looks like in the real world
Carrot Health discusses how Alliance participants are using SDoH to impact Medicare Star ratings, care management and risk adjustment. This presentation took place on January 31, 2019 during the Leveraging Analytics meeting in Fort Worth, Texas.


WEA Trust: Addressing Member Access Issues Through Urgent Care & Behavioral Health Telehealth
American Well's Jasmine Rogness, product management specialist at WEA Trust, discusses how WEA Trust addressed. their issues through telehealth.


Templates: Medical Management Dashboards
Health Alliance Plan shares templates of medical management dashbaords for a variety of audeinces. Included are dashboards for Executves, Management, and the Frontline. Contains dummy data.


Presentation: Automating Prior Authorization: Removing Barriers to Utilization Management
In this webinar, eviCore shares how health plans can continue to benefit from utilization management programs while preserving provider relations and growing networks.


December 2018 Coding Work Group Case Studies
Geisinger Health Plan shares recently coded charts and questions to facilitate discussion on risk adjustment coding best practices during the December 6, 2018 Coding Work Group Session.


Building Payer-Provider Partnerships for Care Management
In this white paper, Navigant Consulting Inc. and the Health Plan Alliance share eight strategies for success in care management. Based on research among three leading provider-sponsored health plans (Health Plan Alliance members), the paper provides real-world examples of how payers and providers can collaborate successfully in developing care management strategies and reducing per member per month costs.


Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries
Delivering food to nutritionally vulnerable patients is important for addressing these patients social determinants of health.


Presentation: Population Health and Care Management for Complex Patients
Adventist Health Plan shares how they used traditional population health approaches,complemented by a complex care management clinic and team of health care professionals, to manage a rural population of families, adults, and seniors and persons with disabilities (SPDs) to meet their health care and social needs in a quality, cost efficient manner.


Care Management Satisfaction Survey
Network Health Plan provides an example of a care management satisfaction survey.


Presentation: How to achieve a 10:1 ROI on care management programs AND reduce disenrollment and close gaps in care
Welltok will share how they support and drive value for Health Plan Alliance (HPA) members. They will also share how there award-winning consumer activation platform, advanced analytics and multi-channel communications help health plans increase member retention and satisfaction, drive engagement and improves healthcare value.


Presentation: Exploring the Information Gap and Solutions
Change Healthcare consultants identify common problems and scenarios facing health plans and providers and discuss technology and solutions for developing encompassing data-sharing capabilities with the goal of improving health by engaging patients and communities. This presentation took place June, 2018 during the Health System/Health Plan Value Visit in Chicago.


Numerof: The State of Population Health
Numerof & Associates teamed with Dr. David Nash, Dean of Jefferson College of Population Health, to study the evolution of population health management. Report is based on a survey of 400+ C-suite healthcare executives.


White Paper: 10 Reasons to Outsource Your Health Risk Assessment
The Health Risk Assessment (HRA) is a critical tool for population health management, developing wellness interventions, and encouraging lifestyle changes to control healthcare costs. It's a valuable resource to help you tap into data to measure the health of your population, risks for chronic disease, and the outcomes of your wellness initiatives.


Presentation: Medicare Diabetes Prevention Program Follow Up Roundtable Discussion
Joe Ledbetter and Elizabeth Goff of IU Health Plans will provide an update on the status of their discussions with their Indianapolis YMCA and Natasha Goburdhun, VP of Business Development and Operations with the YMCA of the USA Managed Services Organization (MSO) will also share an overview of their organization and how they are working with YMCA's across the county who provide DPP services.


Presentation: Beyond DM: A Population Health Evolution
Representatives from Avera/DAKOTACARE share an overview of their organization's evolution from outsourcing case management and disease management programs to in-house programming to now merging the medical management teams from two separate health plans.


Presentation: Using data insights to support care management activities
In this presentation, Sentara shares how they are tailoring services for population health management and value based purchasing, and the efforts they are making to detect high-risk members, engage them, and design programs for care management to optimally promote high-quality, cost-effective healthcare.


Behavioral Economics Based Incentives for Digital Health
A NIH funded study completed by VAL Health to measure the impact of the VAL Health Rewards behavioral economics-based incentives on a digital tobacco cessation program. The result? The control group had a 17% program completion rate and the VAL Health intervention group had 54% program completion.


Looking for utilization management guidelines for auth determinations?
As you prepare for your NCQA accreditation and/or update your utilization management (UM) workflow documents, reference these health plan policies, procedures and guidelines for industry best practices and standards.


Presentation: Innovation Session: Blending enrollment with onboarding and care management phases
Many beneficiaries newly enrolling in MA do not participate in important Care Management programs, due primarily to the limited success of costly health plan engagement efforts. This session explores how process, technology and focused public/private collaboration can quickly address this shortcoming, beginning at the Point of Sale. In a new pilot approved by CMS for the 2018 AEP, Bloom Insurance Agency is testing the theory that gathering health status (HRA) and a complete provider and Rx profile in conjunction with the enrollment, will result in more seamless, efficient and effective care and a more loyal member from day one. In this session, Bloom shares details about the program?s goals, feedback from CMS thus far, and how they see sales, compliance, and quality all coming together for a better member experience and more efficient use of health plan resources.