Leaders at Medicaid managed care organizations rely on ReferWell to drive efficient care transitions through the last mile for low-income, at-risk members and their families. With an EMR-agnostic technology platform and operational support, ReferWell helps payers covering millions of lives improve their members’ health with better access to providers and community partners, increased member adherence to recommended care and enhanced coordination. ReferWell leverages the referable moment so more members complete appointments, close more care gaps and improve outcomes.

Challenges Solved for Medicaid Plans

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Drive Member Access to In-Network Providers and SDoH Services

ReferWell shortens the average wait time for a member to see a specialist by 25% with point-of-care scheduling and a broad network of community partners and specialists accepting Medicaid.

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Achieve Better Member Adherence & Outcomes

ReferWell more than doubles Medicaid member follow through with care by allowing your plan’s provider network and care navigators to schedule care at the referable moment. When members get the care they need, they avoid unnecessary health challenges and ED visits.

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More Care Gaps Closed

ReferWell impacts 77% of Medicaid members we engage to close more care gaps. That includes gaps in care for colorectal and breast cancer screenings and retinopathies.

More Coordinated Care

ReferWell has increased specialists’ loop closure threefold with intuitive technology and an expert operational support team that makes it easy to share clinical notes and improve care coordination.

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Reports With Impact

ReferWell reports on member and provider behavior in real-time, giving your plan insights needed to take corrective action.

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“ReferWell connects our members to providers and SDoH partners who help them live their best lives and improve their health outcomes.”

– Executive Medical Director, metropolitan Medicaid MCO

Start closing care gaps today.


See how ReferWell impacted 77% of members' care gaps for colorectal cancer screening (COL). Get your copy of the case study now.

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Explore Solutions for Medicaid MCOs

ReferWell

Improve member access to specialist care, increase adherence and coordinate care.

StarWell

Identify, call and schedule high-risk members for care gap and specialist visits.

RiskWell

Empower HCC coding and reimbursement and schedule follow-up specialty care at the
referable moment.

MindWell

Provide nationwide access to behavioral health specialists in the ReferWell Telehealth platform.

About Medicaid Managed Care Organizations

Each US state designs its own Medicaid program in accordance with federal rules. Most states use private health insurance plans known as Medicaid managed care organizations (MCOs) to deliver comprehensive health care to Medicaid beneficiaries on behalf of the state. Those who qualify for Medicaid include low-income individuals, certain pregnant women and children and others as determined by the state.

Like Medicare Advantage plans and accountable care organizations, Medicaid MCOs accept a set (capitated) per member per month payment for the services they provide and are therefore incentivized to provide the most efficient, highest quality care at the lowest cost.

Member compliance with recommended care is a chronic pain point for Medicaid plans, as beneficiaries follow through with appointments just 34% of the time on average. 

Medicaid plans are increasingly looking to Social Determinants of Health to improve members' overall health. Plans that facilitate access to services such as nutrition counseling, food security, housing and more find that a holistic approach to health care improves member outcomes.