For Medicare Advantage Plans

The high risk Medicare patient presents unique challenges, yet often are lost in the health care system, with poor health outcomes and high costs. CMS wants this to change, and awards Quality Bonus Payments and rebates to Medicare Advantage Organizations (MAOs) that demonstrate an ability to improve the health among this population. Edumedics works with MAOs to help their plans earn high Star Ratings by providing our care solution to this population, all the while tracking and reporting on key HEDIS measures.

How it works

Sustainable program with tangible value

care solution

Care Solution

Edumedics’ clinical team becomes personally engaged with at risk members, providing personalized care and empowering members to better self care through education and tangible action plans. Key clinical information is gathered and shared with the member’s primary care provider, improving care coordination and healthcare resource consumption.

integration

Integration

Edumedics is flexible and works within a Medicare Advantage work plan and workflow. By integrating MA plan data with clinical data, we are able to be intentional in our service provision, targeting at risk members, closing care gaps, improving HEDIS measurements, and verifying diagnosis documentation.

report

Report

Our technology platform captures critical data elements, which can be securely exported on a scheduled basis to the MA plan. This functionality is performed in a way that meets the MA Plans’ unique workflow, data warehousing and reporting requirements.

With Edumedics you can…

  • Improve high risk member health. We combine personalized education, telehealth and face-to-face care to engage members and encourage behavioral changes that lead to improved satisfaction and health.
  • Track and report HEDIS measures seamlessly. Data collection and reporting is easily transmitted via our proprietary Healthward™ platform, removing barriers to collection via manual inspection and retrieval. This directly impacts a MA Plan’s Star rating.
  • Improve MLR. Documentation of high risk MA members can be achieved through our care solution by understanding the member’s unique challenges and comorbidities and providing education on standard health guidelines. We strive to improve the primary care relationship and encourage proper healthcare resource consumption.
  • Integrate with existing systems and workflows. MA Plan workflows are unique. Edumedics will integrate with the tools you use and the way you work so communication is fluid, data is secure, and our partnership is seamless.

Read the case study: Kate lowers her numbers, enhances her life.

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Trusted and proven to work

  • 50% decrease in people with diabetes with hemoglobin A1C greater than 9%
  • 13% decrease in dangerous blood pressures
  • 95% of people with diabetes have documented hemoglobin A1C less than 9%
  • 74% of people with diabetes have documented LDL less than 100
  • 73% of those with high blood pressure have documented blood pressure of less than 140/90
  • 95% satisfaction reported by members in Edumedics programs

Ready to get started?
Get in touch and we’ll show you how we can help.