ComplexCare Solutions offers a modular suite of services that can work together or independently to meet customer needs.
As part of our services, we offer a proprietary process for identifying members who are the most impactable. These are members who might be non-adherent to their medication regimen or unaware of their health risks but who show potential for change. Using our proprietary algorithms to analyze claim data along with other non-traditional assessment information, we find the members who will benefit most from our services. This selection process continues throughout our partnership with you. As members' lives change, they shift in selection priority.
It all starts with member engagement
Once selected, we employ a multi-pronged approach to engaging members that delivers industry-leading results. Our workforce members, which include employees and delegates, are specially trained and supported by state-of-the-art technology that helps us scrub lists, schedule appointments, and efficiently collect data. When possible, we use the power of our customers' brands to establish trust and build relationships that keep members actively engaged in improving their overall health.
ComplexCare Solutions offers both face-to-face and telephonic assessments that meet CMS, State and NCQA standards. Our assessments produce:
- A high return on investment
- High rates of member engagement
- Greater than 98% coding accuracy
- 94% member satisfaction
Our assessment services provide valuable data to health plans about their members, particularly those who are high risk or not well connected to care delivery. The licensed practitioners are trained to identify urgent and non-urgent escalations, and follow plan-specific protocol for each. CCS escalates 16-20% of plan members to their PCP for follow-up care.
In-home assessments
ComplexCare Solutions has extensive experience and capabilities for administering in-home Health Risk Assessments (HRAs) and Annual Wellness Visits. Our strength is in accurately evaluating the member's medical condition and looking beyond the obvious to identify behavioral, economic, environmental and social determinants of health. During an IHA, we can assess eligibility for case management and make referrals, as appropriate.
Our assessment process can address multiple Star measures and provide point-of-care testing, including diabetic retinal examinations, HbA1c, and urine microbumin testing.
In order to more efficiently meet customer needs, CCS uses electronic forms, which can be pre-filled with information received from the health plan.
Functional needs assessment
ComplexCare Solutions also offers medical, psychosocial and functional assessment to determine eligibility for Activities of Daily Living (ADL).
Coding
When a licensed practitioner completes an assessment, it is queued to our experienced coders for review and diagnostic code entry. A seasoned team of certified coders and a rigorous quality review process provide a second-level review to qualify and validate all information is captured, supported and reported. 100% of CCS coding is done using certified CCS employees. CCS' medical coders have an average of 10 years of coding experience. As a result, CCS boasts an average annual coding accuracy of 96%.
ComplexCare Solutions offers a variety of programs that can complement our assessment services for greater impact and results. All of these services are aligned with new CMS best practices.
Stars program
To improve your Star Ratings, CCS uses face-to-face intervention to identify, monitor and close specific gaps in care that have bearing on your ratings. Working closely with you, we determine which measures require immediate attention and can be impacted quickly. Our assessments can gather data on such Star measures as:
* Included free of charge with Annual Health Assessments
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