Medicare Advantage
Connected care and utilization management for Medicare Advantage programs
Lower costs and improve outcomes for complex and vulnerable populations
Efficient whole-person care is in our DNA. We leverage our decades of experience integrating behavioral health with medical care and social determinants to help you streamline operations and overcome barriers so you can close gaps, improve efficiencies, and address targeted care outcomes for even the most complex populations. Our solution helps you support your Medicare Advantage, dual-eligible, and special needs plan programs more effectively.
Efficiently grow your Medicare Advantage business
Our enterprise care and utilization management platform is designed for configurability and scalability, empowering you to quickly adapt to changing business and regulatory requirements and evolving Medicare Advantage needs..
Support strong Star performance
Medicare Advantage Star performance depends on coordinated execution across quality, care management, utilization management, member experience, and compliance. Incedo brings these functions together with connected workflows, member data, and reporting to help plans identify opportunities, take action, and monitor performance.
- Improve quality performance by identifying care gaps, triggering follow-up, and tracking interventions across the member journey.
- Connect care and utilization management to coordinate care plans, prior authorizations, utilization decisions, and transitions across teams.
- Support health equity by capturing HRA, HRSN, and other physical, behavioral, and social health data within a comprehensive member record.
- Improve member experience with more coordinated care, timely authorization workflows, and greater visibility across member interactions.
- Strengthen oversight and compliance by tracking appeals, grievances, quality measures, and other regulatory requirements.
- Measure performance with configurable reporting and dashboards that provide visibility into quality, utilization, member, and operational performance.
Who We Serve
Care Management Strategies for Medicare Advantage Plans
Care Management
- Close gaps in care and proactively address potential health issues using advanced analytics to ultimately improve patient outcomes and reduce costs
- Collaborate across interdisciplinary teams with a 360° view to close gaps, support transitions, and prevent unnecessary care
- Optimize care coordination to reduce care fragmentation and improve member outcomes.
- Integrate care and utilization management to eliminate information silos
Utilization Management
- Speed turnaround times with automated prior authorizations to improve member and provider experience and prevent treatment delays
- Improve care quality and consistency with integrated decision support
- Reduce compliance risk through regulatory alignment
- Improve satisfaction with better experience and quality performance
Behavioral Health &
SDOH Integration
- Integrate medical, behavioral, and psychosocial care to remove barriers and deliver whole-person care
- Support social determinants of health (SDOH) to connect members with the community resources that can help them with the psychosocial issues
- Improve outcomes and reduce risk of health equity bias
CUSTOMER STORY
Doctors HealthCare Plans: From Rapid Implementation to 4.5 Stars
InfoMC customer Doctors HealthCare Plans recently achieved an overall CMS 4.5 Star Rating, with Incedo supporting its operations. The partnership began with the implementation of Incedo in just 45 days, providing DHCP with a scalable platform to support its growing Medicare Advantage operations.
Read the customer story to learn how InfoMC helped Doctors HealthCare Plans rapidly implement Incedo and establish the technology foundation to support its growth.
