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ARTICLE Serving Special Needs Faster

The Centers for Medicare and Medicaid Services (CMS) has established Medicare Advantage plans designed to provide coordinated care to individuals with special needs. These beneficiaries are typically older, with multiple conditions that are more challenging and costly to treat.


In the past, Ovations members were mailed a long health risk assessment survey form to help determine their needs. Unfortunately, creating an individualized plan of care through this manual process was costly and could take up to three months to complete.


Ovations wanted to quickly identify members who could benefit most from care management services. The solution was to apply the Rapid Stratification Assessment (RSA) survey tool.


Research from the RSA showed that we could use a much smaller set of questions that can accurately predict which members are at risk for a hospital admission in the coming year.


Based on a member's responses to this new, smaller list of questions, the RSA helps generate a basic individualized plan of care – automatically. This can form the basis of a more complete plan of care that can be coordinated by a care manager. It can also help members better understand their medical condition and communicate more effectively with their care providers.


By using integrated voice recognition technology and telephonic outreach, the average time it takes to determine a member?s plan of care has been reduced from three months to less than three weeks. And, the RSA reduces costs for health risk assessment by more than 50 percent.


The RSA is a great example of how UnitedHealthcare and Ovations are using the power of information to deliver better support to the people who need it most – faster.


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