ComplexCare Solutions

ComplexCare Solutions is a national Care Management and Risk Assessment company which provides services to health plans in support of high risk and complex care needs populations, including; Medicare Advantage, MA Special Needs Plans, and Medicare- Medicaid Plans. CCS operates with clinicians and multi-specialty teams in the member’s home to coordinate and manage the delivery of care, improve member outcomes and reduce the associated cost of care.

With a national footprint in 24 states including Puerto Rico, CCS has a proven record in delivering; best in class conversion rates, superior member engagement, excellent coding accuracy and overall return on investment.

CCS model’s guiding principle is that data-driven tools such as assessments play an integral role in engagement of members and development of care plans. Key differences in the CCS assessment model:

  • Face-to-face assessment in the home
  • Assessment of clinical, behavioral, environmental and social determinants of health
  • More complete capture of appropriate high-risk diagnoses
  • A closer look at pharmacy coordination
  • Ability to seamlessly escalate to care planning and coordination
  • Improved ability to reduce admissions and readmissions
  • Proprietary technology ensures efficiency and a more targeted approach to member engagement.

CCS in-home care management programs use lower-cost community resources avoiding higher-cost facility-based services. Our multi-disciplinary care teams help members achieve care goals through:

  • Intensive in-home interventions for “impactable” members
  • Unique care plan development for each member


A Proven Partner:

CCS has provided NCQA accredited care management services for tens of thousands of members. Aligned with CMS best practices, CCS solutions deliver improved outcomes for plans and, for members, improved quality of life and care
Debra S. Richman
Chief Strategy and Business Development Officer
(O) 347-576-1566 (C) 917-885-7124