MCO Clinical Services

Your health plan’s ultimate goal is improving population health. We help you achieve this through our integrated utilization and care management programs, population health management solutions and clinical expertise. With a clear picture of your members’ needs and a more efficient way to gather and share information with other healthcare systems, you empower members to live healthier lives – one person at a time. Our MCO Clinical Services integrate utilization management, care management, disease management and advocacy services to provide a member-centered approach to managing care.

Conduent helps members navigate effectively through the continuum of care, steering them toward in-plan providers and cost-effective care options.  Our URAC certified clinicians conduct medical necessity reviews using nationally recognized guidelines that result in appropriate use of member benefits. When services do not meet medical necessity criteria, our physician peer reviewers can identify the correct level of care and help achieve cost-effective care management for your plan.

Our care management services identify high-risk, high-cost members. Care managers are skilled at integrating all aspects of care within the continuum. Your plan will realize savings through avoiding hospital admissions, ER visits and medical complications by educating members, monitoring progress and coordinating with providers for early intervention.  This includes wellness visits, preventive screenings, follow-up appointments and more.

Conduent’s Condition Management program provides expertise in targeting members with chronic health issues who aren’t managing their health needs well. Because better self-management makes a difference in quality of life, we support and empower members to make better health and lifestyle choices that improve their health, reduce risk of complications and minimize medical costs.

Complementing Conduent’s clinical services is our suite of software-based tools that help you support population health.   Collection of clinical data allows you to look at patterns of benefit use, and gain insights and analytics into utilization rates across your member base.  This in turn allows for creation of an accurate risk adjusted fee structure.  Analytics on utilization and risk adjustment are key inputs that drive reserve allocation decisions.