Sierra Financial Services has the experience in working with Medicaid Managed Care Organizations (MCOs) to transform their eligibility systems, to recognize the need for additional delivery resources, as well as financial resources, to meet the requirements of the improvement opportunity hypotheses, to design data and metric development for data based analytics, to coordinate design of enhancements, and to transform an overall eligibility approach that results in better health care and better outcomes.

MCOs support the organization of the eligibility process for Beneficiaries for all kinds of insureds, including Dual Eligible patients. MCOs facilitate the work of clinicians to improve outcomes and patient pathways, while arranging a more accurate budget rate for their services, reflecting the specific actuarial cost expectations for the Dual Eligible patient’s treatment costs. MCOs support the service providers with Care Coordination activities that increase efficiency and support patient engagement activities. MCOs support managing revenues under multiple forms of Value Based Contracting (VBC).

With the shift toward VBC models, the need for predictable, sustainable results in a risk environment is facing providers. MCO’s are expected to improve community access and enrollment for the underserved population as well as other segments.

Many studies show that affordable housing, accessible transportation, and sustainable nutrition are the top three needs that communities are facing in providing for their population. Sierra Financial Services has the resources to assist our clients to address these challenging issues, which will result in better care and outcomes for the beneficiaries.

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We Specialize in Medicaid Eligibility, Enrollment, Certification, and Follow-up Services
for Medicaid MCOs and Medicare Advantage Plans

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