Idaho Complete Health
Medicaid Managed Care
Our Purpose
Transforming the Health of Idaho Communities, One Person at a Time
The goal of Idaho Complete Health is to bring together the right people, experience, and resources to provide holistic, quality health care—aiming to improve the health and wellbeing of Idahoans who receive Medicaid. These individuals are often lower-income and medically complex, and may have faced challenges accessing benefits within the healthcare system.
With Idaho Complete Health positioned as a subsidiary of Centene Corporation, it’s part of the nation’s largest managed care company focused on underserved and uninsured populations. As a managed care organization (MCO), we encourage preventive care to help people stay healthier. This reduces the need for additional treatments and care, which can help keep costs down.
Improving Health Outcomes
Medicaid managed care helps connect people who rely on Medicaid—largely those with very low incomes or complex medical needs—with quality health care. By investing in the health of their members and their communities, managed care organizations (MCO) can also be an important part of a pathway to greater economic stability.
Transforming Medicaid: The Power of Managed Care
- 74% of all Medicaid recipients are enrolled in MCOs
- $94 per member per month “PMPM” reduction in medical spend
- 63% reduction in inpatient utilization
- 99.2% of first-time claims were paid within 30 days
Achieving Whole Health
Our approach recognizes the interconnected nature of mental and physical well-being, leading to improved health outcomes and reduced healthcare costs. Our available programs and innovations for our community members deliver meaningful results.
Behavioral Health: Choose Tomorrow®
The Choose Tomorrow Program uses predictive modeling to identify Centene’s members who are at risk for suicide before a crisis arises. The algorithm scans variables such as diagnostic history, demographics and claims data to identify those who may need proactive support. Suicide-related claims decreased by 6% during the timeframe in which members opted in to Choose Tomorrow interventions.
Chronic Conditions: Good Measures Diabetes Telehealth Program
The Good Measures Diabetes Telehealth Program provides telehealth coaching for diabetes patients that includes clinical coaching, technology, and personalized food plans. 57.1% of program members reported an improvement in A1c, a key health indicator for diabetics.
Maternal Health: Start Smart For Your Baby®
Start Smart for Your Baby® (SSFB) uses care coordination, disease management and health education to support well-being of both parents and newborns. SSFB’s enhanced identification model achieved a 97% accuracy rate in correctly identifying high-riskpregnancies across all pregnancies.
Preventive Care: Hazel Health
Hazel Health collaborates with school nurses, providing telehealth through iPads for Medical Doctor, Physician’s Assistant and Nurse Practitioner consultations. They offer 30% bilingual providers and ensure post-visit follow-up with families and coordinated care, helping to reduce student absenteeism and bridge care gaps.
A Local Approach with National Strength
Centene Corporation, a Fortune 500 company, is a leading healthcare enterprise that is committed to helping people live healthier lives. The Company takes a local approach – with local brands and local teams – to provide fully integrated, high-quality and cost effective services, focusing on under-insured and uninsured individuals.
Centene offers affordable and high-quality products to more than 1 in 15 individuals across the nation, including Medicaid and Medicare members, as well as individuals and families served by the Health Insurance Marketplace.
Addressing Member Needs Simply and Efficiently
Provider Features:
All-access Secure Provider Portal—Access all your patient information in one place. View patient records, submit claims, verify eligibility, and more.
EFT & ERA Solution—Need help keeping up with claims payments? Enroll in PaySpan to simplify the payment tracking and transfer process.
Pre-Auth Tool—Use this online tool to quickly determine if prior authorization is required for a specific service.
Provider Resources and Training—Our Provider Relations Representatives deliver education and training, industry news updates, and regular in-service meetings.
Care Management Programs—We support you by providing additional communication to your patients who are under a care plan.
Suicide Safer Care—Idaho Complete Health, an affiliate of Centene, is proud to support the Suicide Safer Care model. Developed by the Association of Clinicians for the Underserved, with funding from the Centene Foundation, SSC helps primary care providers identify and address suicide risk using evidence-based strategies.
Quality means going above and beyond to make sure our members get appropriate preventive care to stay healthy, and that they receive the right care in the right place. This means equipping our provider network with programs and features that keep your interactions with Centene simple and efficient so you can focus on your patient’s needs.
Sources:
Total Medicaid MCO Enrollment. KFF.
From research to realization: How a Texas health plan implemented an academic model of care for Alzheimer’s disease. The Journal of the Alzheimer’s Association, 2021
Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal. Andrea Fiorillo , Norman Sartorius, 2021
How do individuals with behavioral health conditions contribute to physical and total healthcare spending? Milliman, 2020