CareSource shifts to new platform to meet members’ needs

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A new platform for CareSource will enable the insurer to better understand the needs of its 2 million members and get them the services they need to stay healthy.

“Our focus on complex populations requires a comprehensive care management approach because of the interdependencies of their physical, behavioral and social healthcare needs,” says Chris Turner, chief clinical officer.

CareSource is a government insurance firm with its payments coming from Medicaid, Medicare and the Affordable Care Act marketplace. The company has health plans in Georgia, Indiana, Kentucky, Ohio and West Virginia.

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After a vendor selection process that considered 12 companies and covered a number scenarios on how various companies manage care coordination, utilization and outcomes, the company selected the GuidingCare platform of Altruista Health because it has the ability to meet high needs of member populations in real-time, Turner explains.

Vendors needed to show the ability to exhume and incorporate health, pharmaceutical and social determinants data in real time, exchange data with providers, push member health data to providers, and deliver advanced analytics that could identify members who will have the most needs during the next six months, such as food, transportation and other resources.

These social determinants of care can present steep barriers for vulnerable populations in accessing providers and following through on care plans, according to Turner.

Consequently, the GuidingCare platform includes an integrated search and referral tool for social service-related needs that connects care managers with community partners and agencies that link members with the services they need.

“Interdisciplinary care teams can collaboratively and efficiently manage the continuum of healthy to complex populations and achieve the best outcomes,” says Ashish Kachru CEO at Altruista. CareSource care managers have access to tools that nudge them at every step of the way to integrate best practices into managing their members.”

For now, CareSource remains in the planning and design stages as the platform is built, with go-live expected toward the end of the year.

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