MANAGED SOLUTIONS FOR MANAGED CARE
WHAT IS MANAGED CARE?
Managed care is a type of health insurance that helps control costs while improving quality and access to care. Instead of paying doctors for every service they perform (like in traditional fee-for-service models), managed care uses a network of providers who work together to coordinate care. This approach helps prevent unnecessary treatments, reduces costs, and ensures members get the right care at the right time.
WHAT IS MEDICAID MANAGED CARE?
In Medicaid managed care, states contract with health plans—called Managed Care Organizations (MCOs)—to deliver health services to Medicaid members. These MCOs receive a fixed monthly payment per member (called "capitation") and are responsible for managing members’ care, costs, and health outcomes.
WHAT WE DO
Summit Managed Solutions partners with Medicaid health plans and public healthcare programs to strengthen operations, reduce cost of care, and improve program performance. Our team brings deep expertise in managed care to help our clients deliver high-quality, efficient, and people-centered care.
1 / Program Management Office
Our PMO resources support improved communication, quality and ultimately health plan momentum to progress their goals on time and over expectation by supporting new program implementations, project management, strategic planning or tracking against strategic plan actions, risk assessment or continuous improvement reviews for recommendations to innovation, automate or document.
2 / Financial Optimization and Payments
Guide strategic decisions for programs, value-based contracts, and partner agreements; analyzing claims and utilization data to identify new initiatives that result in operational and cost of care savings.
3 / Member and Clinical Quality Programs
Population-specific designed programs managed with our program oversight such as data tracking to monitor effectiveness. Identify process improvement opportunities to streamline, and execute ongoing programs.
4 / Strategic Sourcing
Our approach to strategic sourcing includes vendor management that facilitates direct feedback and collaboration to reduce costs and improve quality and reliability.
5 / Marketing Operations and Growth Strategy
Marketing, outreach, education and communications that consider the needs, choices and general tendencies of this population resulting in differing approaches to when and where we market and educate.
