Stakeholder report 2021
Father and young son on video screen on a telehealth visit with a doctor

Clinical Operations

Improving Efficiency for Better Outcomes

Health insurance works best when there is seamless and coherent communication between the member, the provider and the insurance company. If any of the three pillars fail, then so does the quality of our members’ care. Given the unprecedented health care environment of 2020, CareSource was especially diligent in refining processes and embracing automation in our clinical operations so our members could get quality care, minus the hassles and red tape that too often tangle up their treatment.

Telehealth services have been vital to assure access to care. Long before the COVID pandemic, CareSource was leading the way in telehealth visits for rural and underserved populations. So, when the entire nation locked down, we rolled out our operations on a much larger scale. For providers without telehealth capabilities, we helped bridge the gap and provided the support and technology needed to implement best practices. For those providers with telehealth capabilities, we eliminated many of the restrictions and paperwork once involved.

At the same time, we established a more robust risk stratification process for our members, assigning risk levels to better triage their treatment and assure better outcomes. Ultimately, we would create our own Command Center of CareSource clinical team specialists devoted exclusively for urgent cases that needed the most prompt attention.

For our providers, we realize that every minute waiting on an insurance company response or authorization is a minute that could be spent saving lives. That’s why we continue to enhance automation options for preapprovals and permissions. By simplifying and standardizing our communication with frontline health workers and clinical staff, we’re doing our part to assure that they can do their best work, too.


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