PCH offers Medicare and ACA carriers a unique experience for their members’ access – providers optimized to execute value-based, patient-centered managed care.

Our extensive experience delivering value-based consultations to independent healthcare providers provides these opportunities to access:

• A broad network of experienced, well-trained insurance agents to convert Medicare and ACA panels at providers to your plans as needed.

• Using call centers on patient outreach to provide reminders for upcoming care visits, notice that a preventive test or exam is due and to help schedule visits.

• Enable Value Based Care in ACA and Medicare by aligning services and partnerships that deliver performance to health plan objectives including:

1. Risk Adjustment
2. Utilization Management
3. Coding training and expertise to national and carrier standards pinpointing issues needing correction and opportunities for member engagement and experience    optimization
4. Quality & Outcomes Improvements
5. Value-based arrangements including P4P, Episodic, Shared Savings (Gainshare) and for care coordination.

• Focus on the Plan Liability Risk Score (PLRS) through Dx, Rx, HCC Coding
  and Severity Factor Reporting.

• Compliance expertise in the ACA and Medicare worlds assisting healthcare providers be compliant with CMS, ACA, Medicare and carrier regulations on all needed aspects of business.

• Coordinating appropriate utilization of care from enrollment through screens to health condition capture and ongoing care management.