We assist in the transition to achieve a targeted medical loss ratio (MLR).
Our experienced staff of professionals work closely with the PCPs that are responsible for care delivery to provide education and to support their efforts to control utilization and improve quality scores (HEDIS and PQRS).
Through a Management Services Organization (MSO) arrangement, Independent Living Systems (ILS) relieves health plans of the burden of managing costly segments of the membership. ILS assumes the financial risk from health plans and physicians, and takes responsibility for a plan’s Medicaid membership expenses including hospitalizations, prescriptions, and other costs that the member incurs.
ILS assumes responsibility for implementing improvements and achieving the MLR goal. When cost containment and revenue goals are exceeded, ILS and the health plan share in the savings achieved. In other words - we take all of the risk and share the rewards!
ILS works closely with network physicians to provide both in-person and virtual education and support focused on cost and quality improvements with significant impact to overall HEDIS performance.
Our MSO team becomes an extension of your health plan staff, and in doing so, seamlessly reviews and analyzes data on the membership, and presents a plan of improvement.
Analytics dashboards provide both summaries and detailed information and include; early markers of potentially high cost members and providers, high cost medications, emergency room over utilization and high hospital readmission rates. Analyses available at the member, provider, group, and plan levels.