Care Coordination

healthcare is often complex, frustrating and wasteful.

Healthcare Journey
Patients confused about Healthcare and their plan
50%
Physician Services Duplicated
24%
Patient Self-Referral to wrong Doctor type
61%
stop seeking care without getting needed service
44%

PLAN MEMBERS NEED A GUIDE

Care Coordinators completely replace traditional, fragmented health plan member services with a single, dedicated pod of 25 highly trained, co-located patient advocates. This team handles everything from your plan member obtaining a new ID card to arranging for medical records to arrive at a physician office, to communicating with a surgeon for approval of the most complex medical procedure. Each pod has a nurse practitioner and access to an in-house physician. Plan members quickly learn to access all aspects of their medical benefits through the super friendly Care Coordinators.


plan members need guide

Care Coordinators do much more for members

In addition to handling member issues related to benefits, claims, and network providers, Care Coordinators provide:

  • Patient advocacy
  • Care Management
  • Nurse coaching.

For example, they will:

  • Find a top quality in-network provider
  • Make an appointment
  • Have test results forwarded to a doctor
  • Proactively provide post-surgical instructions

Some care coordinator stats:

  • 35% of their calls are outbound
  • 53% of their contacts are to providers on behalf of members

An integrated hub for all health plan tools

You may have separate vendors for add-on services like price transparency, telemedicine, wellness, centers of excellence, etc.

Care Coordinators make your health plan add-on services better:

  • They act as a hub for these services, actively promoting and referring members to them.
  • They have access to the utilization & claims data for these items. This allows them to be much more effective in acting on behalf of plan members to bridge care.
  • Simplifies things for plan members. They may not remember that they have telemedicine, but the Care coordinator does

Real-time interventions become possible

Plan members need help with the healthcare maze.

Care Coordinators provide real-time interventions that support plan members through the healthcare process, helping them receive the right care. The outcome is happier plan members. And often cost savings to the health plan.

Plan member behavior changes for the better

  • 6.8% reduction in inpatient days
  • 20% reduction in readmission
  • 3.8% reduction in ER visits
  • 13.5% increase in primary care visits