CareBridge is the nation’s leading value-based care provider for members receiving home and community-based services (HCBS). We partner with managed Medicaid and DSNP plans to maximize the health, independence, and quality of life of members receiving HCBS, delivering best-in-class member satisfaction while improving both health and financial outcomes. As of June 2023, CareBrigeserve 84,000 HCBS members across 12 states plus Washington, D.C., and we continue to expand our geographic reach.

CareBridge solutions are specifically designed to address the complex challenges faced by the rapidly growing HCBS population, and the only program in the market committed to improving quality outcomes across the continuum (health, independence, and quality of life), while managing both medical and HCBS spend.

24/7 Member Support delivered by the CareBridge Medical Group provides person-centered in-home medical and behavioral health care and coordination of social support needs that is accessible any time, day, or night, at the push of a button. Much more than a typical telehealth model, we deliver proactive, preventative care for each person via a specialized, multi-disciplinary, virtual healthcare team (made up of physicians, nurses, psychiatrists, pharmacists, behavioral health specialists, and social workers). The team reviews each member’s plan of care and medical records, then performs a comprehensive clinical assessment to develop a personalized treatment and education plan that drives ongoing, culturally sensitive engagement with each person and their care team. Our virtual first approach provides a cellular-enabled tablet which allows for immediate access to care via video visits and secure chat/text that can be initiated by anyone in the home, including caregivers. We coordinate with health plans and PCPs and also work to close gaps in care that drive quality ratings and capture risk adjustment factors. Because the program is virtual, it is able to scale. Our programs are producing strong financial results (between 8-18% MLR Improvement in the 1st two years of the program), HEDIS / STARS improvements (achieving 5 STAR levels on quality measures), and high member satisfaction (Net Promoter Score of 84).

Decision Support provides health plan care managers with actionable recommendations on the type and levels of HCBS that will optimally help members achieve greater independence and control in their lives while helping to address critical HCBS workforce shortages and manage HCBS spend. To develop these recommendations, our team of clinicians with occupational and physical therapy training and expertise utilize the nation’s largest HCBS analytical database and personalized medical information to identify current utilization patterns, then complete an individualized member assessment identifying potential enhancements to the member’s care plan, including “empowering alternatives”—services such as assistive technology that are specifically designed to help increase independence in daily living. The result is increased member independence and quality of life, while lowering overall HCBS costs by 10-15%.

As part of the Decision Support product CareBridge supports Benefit Alignment by educating unaligned dual eligible members about the benefits of choosing to receive their Medicare benefits through the health plan partner’s DSNP. The result is improved member experience and satisfaction, while increasing opportunities to improve care outcomes and health plan revenue.

CareBridge also provides best-in-class Electronic Visit Verification and Data Aggregation services to Medicaid health plans, that can be customized to support state and plan preferences. The EVV solution is fully compliant with the 21st Century Cures Act, offering both standard and customized validation options with claims generation capabilities.

Todd Leri

Chief Growth Officer

926 Main Street
Nashville, TN 37206