Our Innovation

Decision SupportOur Innovation

You can’t manage what you don’t measure.

Cenpatico leverages best-in-class business intelligence delivery to ensure a data-driven approach to all aspects of managing the care of our members. We continuously monitor all aspects of our business, including utilization and case management trends and projections, provider network composition and adequacy, quality and performance improvement, and overall member population behavior and outcomes.

Our Decision Support Service team provides ongoing production and ad-hoc reporting, data mining, statistical analysis, predictive analytics, and data visualization.

We offer a complete picture of the systems of care for our members, turning data into actionable information to support continuous improvement across our portfolio of services.

Behavioral Health

We develop provider networks, in both urban and rural markets, with broad cultural diversity that offer the most choice for our members. We support peer services, particularly in rural areas, where access to clinicians may be more limited, and creative solutions, such as telehealth. In every market, we identify providers with special expertise in meeting the unique needs of the populations we serve. We contract with hospitals, chemical dependency treatment facilities, community mental health centers, and individual providers, such as psychiatrists, advanced nurse practitioners, psychologists, and master-level clinicians. We collaborate with our providers to make sure the most effective treatment practices are offered.

In Indiana, we partnered with two agencies to bring a Respite program for our families, to help avoid unnecessary hospitalizations for teenagers, when a time out was needed.

Our knowledgeable, independently-licensed behavioral health professionals perform clinical reviews for pre-certification, concurrent, and retrospective authorization requests, using InterQual, nationally recognized medical necessity guidance. Our utilization management techniques ensure that our members get the right care at the right time. We offer free continuing education for providers to help them stay up to date on the latest evidence for treatments. We also sponsor local trainings on topics relevant to our membership or to meet identified gaps in service knowledge.

For example, in Georgia, we sponsored training in the Strengthening Families Program, an evidence-based practice that helps youth and their families build skills.

Importance of Our Work

At Cenpatico®, there is no such thing as the status quo. We are innovators, and we are proud of our accomplishments.

We have introduced pilot programs and new products, in all of our markets, that are tailored to the needs of that specific population:

Cenpatico’s psychotropic medication utilization review (PMUR) process, created in 2008, has produced improvements in oversight and monitoring of psychotropic medication use in children in the Texas foster care system. The subsequent policy and health care delivery model changes have resulted in improved medication utilization for children and youth in foster care.

Boy holding Hope Bear - Our Innovation

We recognized a lack of coordination for children, so we introduced our Hope Bear program. This program provides members ages 4-18 with a package containing a Hope Bear, a $10 gift card and a book about feelings, when a member attends their 7-day follow up appointment following discharge from the hospital. We have increased follow-up appointment rates by 3.5% since 2007.

We discovered that reaching members after discharge from the hospital is often challenging in some markets, so we introduced our Caring Voices program. This program provides members with free cell phones that are pre-programmed with numbers for their providers and our clinical staff; this is particularly helpful for members that do not have a stable place to live. We have reduced inpatient admissions by 43% for members who participate in this program