Resolve™

A One-of-a-Kind Solution for Health Plan Consumer Engagement

Resolve is the only end-to-end medication adherence customer relationship management (CRM) system designed to address and resolve consumer barriers to care that lead to poor measure performance, including social determinants of health (SDOH), provider, and pharmacy access. The solution has been integral to achieving value-based care outcomes for more than a decade, with a high level of focus on government programs such as Medicare Advantage Star Ratings, Managed Medicaid Pay for Performance (P4Q), and the Commercial ACA Quality Rating System.

Offered as either a tech-enabled service that combines the mind of a clinician with the heart of a social worker, or a fully configurable SaaS-based solution, Resolve is a comprehensive offering within the Adhere™ platform that analyzes near real-time data from dozens of sources within a streamlined intelligent clinical workflow to maximize health plan outcomes.

Resolve proactively and dynamically identifies and analyzes which consumers are at risk of medication non-adherence, gaps in quality measures, and poor Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and Health Outcomes Survey (HOS) results, stratifying at-risk consumers for outreach to optimize engagement. The Adhere platform’s flexible integrations with SDOH and pharmacy partners enable clinicians to seamlessly connect consumers to the resources they need – thus improving outcomes and individual Medicare Advantage Star Ratings measure performance while elevating the consumer experience.

Resolve enables plans to improve scale and performance for their clinical teams to target both medication adherence and related quality measures in a consumer-centric way, leading to improved outcomes and cost savings for plans across markets.

Analytics

Analytics

  • Integrates all necessary data from dozens of sources such as pharmacy, medical, CAHPS® and HOS, Healthcare Effectiveness Data and Information Set (HEDIS®), eligibility, hospital discharge, and provider- and consumer-reported SDOH
  • Stratifies consumers into daily call lists based on risk, assigning the lowest-cost clinician for each consumer engagement
  • Provides deep insights into call center performance and each projected Star Ratings measure forecast
Engagement

Consumer Experience

  • Optimizes each engagement by addressing multiple gaps in care in a single outreach using the platform’s holistic view of the consumer’s journey
  • Allows for consumer stratification that mitigates the risk of member abrasion and improves consumer experience to positively impact CAHPS® scores and MA Star Ratings
  • Prompts clinicians to ask consumers about their access to care and provide assistance in navigating across the care continuum
Compliance

Intelligent Clinical Workflow

  • Guides clinicians through behavioral coaching techniques to identify the root of consumer barriers
  • Enables clinicians to connect consumers with multiple SDOH-focused community resources and embedded health plan benefits
  • Offers a range of pharmacy resources for consumers of various risk levels with Pharmacy at Home integrated solutions, including mail order, PillPack by Amazon Pharmacy, and AdhereRx
Business Analytics

Business Analytics & Reporting

  • Real-time data visualization of outcomes and program performance across populations
  • Connects with hundreds of data sources to create executive dashboards and ad hoc analyses
  • Enables multiple scenario-based forecasting combining quality measurement and financial investments

Benefits

Social Determinants of Health

Dynamic engagement with consumers that focuses on socio-economic issues for access to care

Quality Bonus Payments

Increased value-based care revenue due to improved quality measures

Cost Savings

Actuarial evidence of bending the trend of unnecessary healthcare costs by better medication adherence

Full Risk Guarantee

100% guarantee on each consumer measure conversion performance

CAHPS and HOS Outcomes

Consumer-centric CRM model positively impacts CAHPS measures by addressing multiple measure gaps in a single engagement, mitigating risk of abrasion

Resolving Outcomes

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How We Make an Impact

Real Consumer Stories

Data-Driven Tools

Stratify™

Stratify™ predictive analytics identify medication adherence and care assessment gaps using comparative benchmarks that support targeted consumer and provider engagement.

Quantify™

Quantify™ builds actionable client-specific scenario modeling for value-based care incentive structures and incorporates Stratify™ analytics to achieve targeted outcomes.

P3Link™

P3Link™ is a regulatory compliant clinical workflow for Medication Therapy Management (MTM) that uses Stratify™ analytics to guide interventions.

QiLink™

QiLink™ is a clinical workflow using decision support to guide gap closure for clinical and non-clinical interventions with consumers and providers using Stratify™ analytics.

Discern™

Discern™ is a business analytics solution that provides real-time client data visualization of outcomes and program performance.