Summary of Impact

One of the largest Medicaid health plans in the U.S. partnered with PDHI to enhance its health risk assessment (HRA) process, improve member engagement, and support NCQA accreditation. By adopting the ConXus Platform, the plan improved HRA utilization, informed outreach and care management with timely data, and empowered members with tailored engagement tools.

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Challenge

The health plan aimed to:

• Improve member engagement
• Manage care more efficiently
• Obtain NCQA accreditation

They needed a new leading data source to strengthen analytics, identify risks and trends, and adapt quickly to evolving regulatory requirements

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Solution

PDHI provided members with a comprehensive HRA that:

• Meets NCQA and Medi-Cal requirements
• Is accessible via any device with single sign-on from the member portal
• Includes questions on Social Determinants of Health (SDOH), Sexual Orientation and Gender Identity (SOGI), and Language Diversity

Seamless integration with the plan’s care management and EHR systems ensured providers had timely access to member data. The platform also delivered:

• Personalized self-management tools tailored to risks, goals, and needs
• Access to the Healthwise Knowledgebase for evidence-based resources
• SMS and email messaging for outreach and engagement
• CA Health Plan Case Study

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Results

• NCQA Accreditation: Received auto credit for WHP 5 & 7
• Improved Utilization: Increased health assessment usage from <1% to a projected 10% within the first year
• Better Care Management: Data integration informed outreach teams and enabled proactive interventions
• Tailored Engagement: Tools configured by line of business improved satisfaction and outcomes
• CA Health Plan Case Study

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In Their Words

"Our population health management solutions are customized to meet the unique needs of California's health plans. Through our highly configurable NCQA offering, we help our clients navigate complex regulations and facilitate secure data sharing, empowering members to take control of their health journey while enabling plans to meet requirements and stay ahead of the curve."