CCS Advantage®: Care Management
MedAssurant’s CCS Advantage integrates care coordination, member health improvement, risk score accuracy, and CMS five-star quality ratings to positively impact clinical and financial outcomes. The program supports members with diabetes, heart failure, coronary artery disease (CAD), asthma, and chronic obstructive pulmonary disease (COPD). Using targeted, member-specific, site-specific and provider-specific analytics, CCS Advantage achieves the right intervention for the right member, in the right venue, at the right time.
Occurring locally in the provider’s office or in a MedAssurant clinical center, face‐to‐face visits give the opportunity to assess fully the member’s true health status by gathering more than self‐reported information. Face‐to‐face visits in local centers (called In-Market centers) offer the opportunity to integrate verbal and non‐verbal queues to effectively educate and coach members. Members are able to demonstrate they understand self‐care process such foot assessment, and performing peak flow. These In-Market visits complement and coordinate with call center interventions.
As a NCQA-accredited program, CCS Advantage reinforces members’ relationships with their providers and compliance with evidence-based treatment through communication and collaboration on the member’s Plan of Care. Our innovative and member-centric approach to care coordination and enhancement improves health, increases treatment adherence, lowers unnecessary utilization, and connects members to much-needed community resources.
Aggregate multiple data sources to create a comprehensive picture of member health
MedAssurant aggregates information from health plan claims, electronic medical records, prescription, lab, emergency room and hospital admission data, as well as from data provided directly by individual physicians and members to create a complete picture of the member’s health and diagnoses.
Analyze data to identify members for inclusion in care management programs
MedAssurant uses predictive, retrospective, and concurrent health care information to identify members and assign them priority based on their current health status. Using clinically proven algorithms and coordination tools like CareSync Advantage®, the right members are identified for CCS Advantage and prioritized for outreach.
Validate information through medical record review
CCS Advantage integrates risk score accuracy into its data set for a more in-depth member profile and to enhance revenue recognition. This deeper investigation provides a more complete member profile that produces a positive risk adjustment impact for the health plan while most importantly improving the lives of the members who benefit from care coordination.
Inform through ongoing tracking and reporting
MedAssurant provides transparent access to program results through a secure client-web portal giving our clients 24/7 access to the process, results and reporting in aggregate and at the individual member level.
Improve the physician and patient relationship
MedAssurant’s CCS Advantage opt-in program successfully engages a high percentage of eligible members. Welcome packages are mailed to members to formally inform them of their eligibility for CCS Advantage and the benefits of enrolling. Subsequently, MedAssurant Communication Center nurses follow-up with a phone call to encourage enrollment into the program. MedAssurant’s proprietary Plan of Care, distributed to the physician and the member, gives insight into the member’s true health picture and steps needed to improve health and adherence to the physician’s treatment plan.