Summary

AmeriChoice Health plans have approximately 133,000 Medicaid and Medicare members, many of whom are racial/ethnic minorities. As part of its growth plan, management had a three-fold objective:

• Decrease customer attrition through the development of targeted programming
• Decrease medical expenses due to misuse of health services
• Integrate member related information between payor and provider to improve service

Process

M. Davis and Company, Inc. designed and administered a health assessment survey to provide information needed to create the foundation for future planning. The survey was administered to over 25,000 members, during a fifteen-month period, via Computer Assisted Telephone Interviewing. Interviews were conducted in English, Spanish and Russian. The survey/assessment was a “proprietary” design and MDAC developed all necessary computer programming and processes for the Health Assessment Data Management System and provided the client with online, real-time access to both the data and a dashboard of reports

Results

The following results were achieved:

• Compliance with mandatory reporting requirements
• Preliminary snapshot of the health and financial risks of new customer populations
• Development of the historical baseline for negotiating capitation rates
• Reduced the health plan’s financial exposure by initiating better management of high risk health plan members identified during the survey process