Commercial Health

Commercial Health


By 2015, it is projected that 75 percent of Medicaid beneficiaries will be enrolled in Medicaid Managed Care plans, including populations that have traditionally been excluded from managed care, such as the disabled, dually-eligible consumers and consumers receiving long-term services and supports (LTSS).


As states become more sophisticated purchasers of managed care services, they are holding plans accountable to reduce unnecessary expenditures demonstrate increased access to primary care and coordinate physical and behavioral health care through the adoption of health homes and quality improvement activities. This trend presents particular challenges to Commercial Health Plans (Managed Care Companies) operating Medicaid plans in multiple states. The ability to monitor and track performance on a diverse set of contract requirements and outcome targets is essential to maximize value-based incentive payments and avoid financial penalties, frozen or capped enrollment and costly corrective-action plans.


CNSI has proven pre-built solutions and products that enable automation of health care administration processes to enable our customers to rapidly deploy programs and systems without the risks associated with new development.


CNSI, with its deep expertise of Medicaid programs, has developed tools and capabilities to help health plans improve contract performance while identifying compliance issues before they result in costly penalties. Tools such as MC-Track, HealthBeat and eCAMS HCE enable the health plan staff to focus on actual health care delivery, and support a more customer-centered culture in all areas of health plan operations.


CNSI has deep health care domain expertise borne out of delivering mission critical systems for more than 14 years. Our solutions are engineered for performance at every level of the systems architecture. We are involved in most major health care initiatives across the country, including consumer engagement to support population health and healthy outcomes, health insurance reform, shift from volume to value-based health care, delivery and payment systems reform and pre- and post-payment health care program integrity. We offer a learning environment, foster an entrepreneurial and innovative attitude, and provide the ability to be involved in the latest technologies.


Based on feedback from top industry consultants, CNSI’s unique knowledge of Medicaid programs and its tools can provide health plans with the right platform to align itself to the changing landscape of compliance, reporting and better outcomes. According to HMA, “MC-Track allows plans to proactively pursue contractual financial incentives and capture at-risk revenue by ensuring compliance and avoiding contractual penalties.” Our visibility enablement platform (HealthBeat) insights can help the plans target the areas for improvement and our pre-payment, predictive analytics-based improper payment solution, which has resulted in over $15M in savings in 18 months for a single customer, can yield true bottom line savings.