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WellCentric DC, a majority women-owned minority business has healthcare executives with extensive experience in Medicaid and commercial managed care programs across the country and in the District of Columbia. Collectively, WellCentric DC is the answer to changing lives and making strides in achieving 2030 Healthy People Goals. Some of our capabilities include the following:
WellCentric DC provides a comprehensive solution that delivers the evidence needed for clients to show compliance with overall access and availability requirements per Federal, State and Local mandates. We will conduct all the necessary activities that demonstrates compliance (e.g. audits, secret shopping, focus groups, etc.) and supports providers with training and Technical Assistance.
Advisory Committee Management
WellCentric DC provides quarterly independent meeting facilitation services to include schedule and membership management, outreach, agenda and topic development, minutes, reporting and closed loop communication. Serving as an unbiased third party facilitator, promotes open and honest communication amongst participants
Adverse Event Support
WellCentric DC will support the clients Patient/ Member Safety program by completing chart reviews, investigations and monitoring of RCA and action plan completion within designated timeframes.
Benefit/ Reimbursement Contracts
WellCentric DC has access to a product portfolio that includes Life, Short Term Disability, Long Term Disability and Critical Illness. WellCentric DC has the capacity to deliver, provide oversight and management of any current Benefit Contracts a health plan has in place.
The expertise of our leadership provides the necessary credentials to lead, guide and instruct organizations in need of effective and transformative operations. We provide program reviews and gap analysis as well as project management services.
WellCentric DC serves as an independent entity able to onboard your membership/ patients to your services and operations in simple layperson terms. We provide ongoing training to both members and staff related to appeals, complaints and grievances. Our technique allows us to obtain unbiased feedback related to barriers to care, report back to the client, and close communication loops resulting in improved customer satisfaction.
WellCentric DC facilitates focused group sessions with targeted audiences to understand experiences, clarify issues, and/or obtain new concept/ program feedback.
Monthly Grievance, Appeals & Fair Hearing Training
WellCentric DC develops content and conducts training based on an organization’s policy for Managed Care Organizations.
WellCentric DC provides facilitation and tracking of Root Cause Analysis, Corrective Action Plans and evaluation or progress of actions within 30 days for Managed Care Organizations
WellCentric DC conducts provider outreach to build/ expand a health plan’s network and improve access to membership via marketing, negotiating contract terms and benefits, and obtaining signatures to facilitate compliance with credentialing and geoaccess requirements.
Policy and Procedures
WellCentric DC develops and maintains policies and procedures related to health plan operations, revenue cycle processes and provider practices
Practice Guideline Management
WellCentric DC coordinates and manages the review, approval, dissemination and utilization of evidenced based practice guidelines amongst the client’s provider network.
WellCentric DC assesses, designs, implements and evaluates programs to deliver health services to a targeted population
Provider Transformation Technical Assistance
WellCentric DC provides Individualized Practice Transformation Support (IPTS) technical assistance and training/ coaching that supports provider’s efforts to provide whole person care by integrating physical and behavioral health to manage the complex needs of patients/members.
Quality Management/ Performance Improvement & Accreditation Readiness Activities
WellCentric DC executes a structured approach to systematically manage performance improvement activities in alignment with an organization’s strategic plan and oversees the quality of services that are provided to its members. WellCentric DC conducts NCQA gap analysis and assists with NCQA Accreditation activities.
Resource Management (Care Coordination), Case Management and Care Transition
WellCentric DC has developed and executed programs to provide services that assist in the organizing of patient/ member care activities and sharing information among all the participants concerned with their care to improve health outcomes. Using nurses and community health workers, WellCentric DC assists members/ patients navigate transitions of care from hospital to post-hospital settings with a focus on education and decreasing readmissions and potentially preventable hospital admissions.
Social Determinants of Health Program
WellCentric DC incorporated social determinants of health into its provider revenue cycle technical assistance training programs. We teach practices how to recognize, address, code and bill for activities that decrease the impact of social determinants of health. In addition, we support case managers by addressing factors that place the individual at risk for diseases and/or disparities in access and /or healthy outcomes.
WellCentric DC designs and executes studies that evaluate the needs and/or impact of external/ internal factors on targeted populations. We conduct telephonic or electronic surveys and report findings, identify opportunities for improvement, make recommendations and develop action plans to close gaps.
WellCentric DC will develop a NCQA or URAC approved Utilization Management Program with annual evaluations. We will evaluate and monitor the prior authorization process for compliance with NCQA/ URAC standards. We will conduct concurrent hospital reviews and retrospective reviews as part of a comprehensive medical management program.
WellCentric DC will develop and deliver a robust and comprehensive wellness program for our clients via their Brick and Mortar or Virtual Wellness Centers. WellCentric DC enhances member engagement through virtual and/ or in-person wellness activities. Our team characterizes the population’s needs through data analysis and identifies and aligns its wellness programs to meet the needs, based on output from its proprietary system. Wellness programs support chronic conditions, pregnancy and workforce development.
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