Our Services - Advantage Health Partners

Care Coordination

Ensuring Every Patient Gets the Care They Need

The Problem

Provider burden - Overworked physicians and staff struggle to meet care coordination requirements
Missed quality measures - High-risk members fall through the cracks
Low patient compliance - Traditional outreach methods are insufficient

The AHP Solution

On-Site Care Coordinators: Embedded in clinics to ensure real-time gap closure
Home Health Assessments: Direct member outreach to capture missing diagnoses and ensure timely care
AI-Driven Patient Targeting: Stratifying members based on real-time claims, lab, and clinical data
Behavioral Science-Based Engagement: Multi-channel engagement that maximizes response rates

EHR Integration & Data Interoperability

Bridging the Information Gap

The Problem

Disconnected systems - Plans and providers operate in silos
Data fragmentation - HCC suspect lists and care gap reports are not actionable within provider workflows

The AHP Solution

EHR-Embedded Gap Closure Workflows: Automating real-time alerts, documentation, and provider decision support
HIE & Bi-Directional Data Exchange: Integrating data sources to create a unified patient record
Regulatory-Ready Data: Structuring data for CMS and HEDIS reporting compliance

AI-Driven Analytics

Precision in Value-Based Care

The Problem

Missed opportunities in risk adjustment - Providers struggle to identify high-risk, undocumented conditions
Low RAF accuracy - Plans cannot maximize reimbursements without reliable data

The AHP Solution

Predictive Risk Stratification: AI-driven models identify the most impactful interventions per patient
Automated HCC Capture: Ensuring accurate risk adjustment submissions
Quality Measure Optimization: Helping plans and providers meet HEDIS, STAR, and CMS compliance targets

Multi-Modal Gap Closure Strategy

Engaging Members Wherever They Are

Provider-Based Engagement

EHR alerts, decision support tools, and in-practice care coordinators

Patient-Based Outreach

Home visits, mobile health units, automated reminders, and patient education

Plan-Based Coordination

Claims analytics, direct member engagement via SMS & IVR, and targeted interventions

Our comprehensive approach ensures that no care gap goes unresolved, utilizing the right channel at the right time to maximize patient engagement and compliance.

Ready to transform your approach to value-based care?

Let us show you how our comprehensive services can drive better outcomes, improve quality measures, and optimize reimbursements.

Request a Consultation