Managed Care

managed_Care_iconAvalon Health Care can provide Care Coordination and Case Management solutions for state-administered Medicaid Managed Care, Managed Care Behavioral Health, and Long-term Care programs through utilizing and integrating with their existing provider network.

The success of managed care is measured by improvements in access, quality and cost containment. These depend on an awareness of the unique needs of the managed care populations, well-established provider networks, effective education of providers and recipients, and fiscally solvent plans with experience in serving Medicaid enrollees. Avalon Health Care working hand in hand with the existing system, integrating acute health services with the long-term continuum of care can help coordinate their services in a cost-effective manor by directing the consumer to the right service or system, at the right time, at the right cost, in order to maximize the resources in a patient centered way.We have the ability to bring all these components together to produce results.

Our services include:

  • Utilization Management of long-term care services using an Interdisciplinary Team
  • Administration of programs that focus on clinical case needs and disease management
  • Coordination with seniors and their families to provide services that support independent living throughout the long-term continuum
  • Work with private managed care and behavior health organizations to ensure that capitation rates are sufficient to adequately care for enrollees
  • Referral and placement of consumers
  • Family Support Services
  • Development of long range service plans promoting health and functional independence
  • Advocacy for patients and families
  • Coordination of services in fragmented health care systems
  • Monitoring oversight of care and service providers