Large MCO Case Study

Improving Outcomes for a Large MCO

How we Connected the Unconnected TM and engaged the most challenging members to improve outcomes for one of the largest MCOs in the nation

The Challenge

Identifying unmet social needs for health plan members can be difficult. This becomes even more challenging when you can’t reach the members to begin with. Engaging high needs Medicaid members can be a huge barrier to better health and is a consistent challenge for even the most innovative health plans.

That is why one of the largest health plans in the country partnered with GroundGame.Health to engage their most unreachable population. Traditional outreach methods weren’t delivering results, so this health plan realized a new approach was needed.

The Solution

GroundGame.Health utilized a standardized evidence-informed care transitions and care coordination model fully aligned with NCQA principles for person-centered care. We identified and met the social impact needs of these members on our patent-pending HITRUST certified closed-loop platform. We securely flowed data and resources between the health plan and our network of community-based care coordinators to engage these previously hard-to-engage members at ground level.

The Results

By connecting the health plan, our network of community-based care coordinators, the previously hard-to-reach members, data, and resources, GroundGame.Health was able to help the health plan achieve:

  • an 84% engagement rate
  • 29% fewer inpatient hospitalizations
  • 2.8x improvement to medication assessment scores
  • 1.7x increased likelihood of members to schedule and attend their annual PCP visit

The combination of everything GroundGame.Health was able to achieve on behalf of the health plan led to meaningful results, including an improvement to member experiences that ultimately boosted star ratings and HEDIS scores.