Discover how a health plan, a population health organization and an in-home provider collaborated to build an integrated model of care for members at high risk for hospitalization and emergency department (ED) utilization. 

This session explores how the partners combined Arizona Complete Health’s Medicare Advantage data and engagement teams with Adobe Population Health’s proprietary risk-stratification tool and MASLOW© app. 

Attendees will learn how data analytics and a unique hybrid telehealth model—combining an in-person medical assistant with a remote clinician—work together to build comprehensive, targeted care plans. By bridging these resources, the model successfully improves member engagement, mitigates social drivers of health (SDOH) risks and optimizes provider utilization, ultimately driving down hospital readmissions and ED visits.

This discussion is best suited for healthcare leaders, case managers, data analytics teams and anyone interested in innovative care models designed to improve outcomes for high-risk populations.

Learning Objectives:

• Explain how combining payer analytics and case management tiering can be used to identify high-risk Medicare Advantage members. 
• Demonstrate how integrating analytics, Social Drivers of Health (SDOH) screening and a hybrid telehealth provider model reduces member utilization. 
• Describe the cross-sector partnership framework utilized to improve quality and reduce avoidable member utilization.