The Centelligence platform drives not only the identification of these high-risk members, but it also sends out internal alerts to call-center representatives, case managers and medical management employees. With access to healthcare history on each individual member, Centene is able to contact its high-risk members, either through inbound or outbound calling, Web portal interaction and the IVR system to educate its members on preventive healthcare and intervene to ensure better outcomes.
More than 1,000 internal business users use Centelligence at least once a week, with several hundred using the platform as their primary decisionmaking tool. Separately, thousands of external medical providers use the system each month to assist in their day-to-day interactions with members. Also, there are currently 40 full-time IT and business partner staff members on the team who work closely with the platform.
Centene has conducted a number of innovative studies to determine the best way to intervene in high-risk pregnancies. Today, they request all pregnant members or the member's physician to complete a “notification of pregnancy” health-risk assessment and score it using Centelligence, allowing Centene to put its high-risk members into a case-management program designed just for them (StartSmart for Your Baby). Using historical data from prior pregnancies, there have been situations in which Centene uses drug intervention such as the alpha-hydroxyprogesterone caproate (17P) treatment to significantly reduce preterm births and increase the average birth weight of deliveries.
The Centelligence platform is core to Centene's mission: better health outcomes at lower costs. It helps to identify high-risk members—based on demographic information, lab results, health-risk screenings, medical claims and more—and uses this knowledge to help members manage their health as a means for preventive care.
This solution impacts medical costs—since implementation, more than 40,000 high-risk members participated in case management (about 3% of Centene's membership) because of identified high-risk conditions. Each month, several hundred thousand medical claims inquiries, eligibility verifications and care-gap alerts have been supported by the system since go-live over Centene's Web channel. And, with the increasing integration to Centene's call centers and IVR platform, the solution supports 100% of all IVR transactions and will support all call-center staff this year as they are trained on the new system.
The upgrades Centene has made to its EDW and the Centelligence platform have made identifying high-risk members and communicating with those members efficient and inexpensive. In addition, the mechanisms for outreach have achieved scalability without linear headcount cost increases (as the organization grows geographically and organically, the solution will scale with it). Through the use of these systems, as well as related investments, Centene is projecting double-digit top-line growth and is managing to improve member outcomes and lower overall costs.