Improve enrollment efficiency for managed LTSS (Managed Long Term Care) health plan
A managed long-term care community-based health plan (managed long-term services and supports)
Health plan leadership desired to improve the efficiency of the prospect pre-enrollment process by replacing several home-grown systems and Excel spreadsheets that were being used to manage pre-enrollment operations and referrer communication. In addition, the organization sought to improve relationships with referring entities by offering a self-service portal and improved case communication.
Status:Go created a pre-enrollment operations platform including desired functionality:
- Self-service referral portal allowing inbound post-acute care providers to submit new referrals and access referral history
- Prospect information gathering workflow allowing intake specialists to collect prospect interest, demographics, and determine eligibility, including phone system integration
- Schedule, dispatch, and manage wait list of in-home assessors for community health assessment collection based on availability, skill set, language fluency, and geographic location
- Assessment gathering, rework, approval, and review process for program eligibility submission, including digital document management integration
- Automated follow-up workflow activity requirements and assessment management at predetermined intervals
- Average turnaround time for eligibility determination and approval was reduced by 41%
- Increased efficiency of assessor workforce eliminated plan to hire additional nurses
- Unutilized assessor availability was reduced by 11% with new wait-list management functionality
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