Medicaid members with behavioral health conditions pass through emergency departments, inpatient units and outpatient follow-up as though each were a separate system. For most plans it is, and the members who need coordination most are the least likely to get it.
CareSource Indiana built a bridge across those settings. Working with a technology partner, the plan paired AI with human-in-the-loop navigators to identify pivotal moments in a member’s care and route that member to the right next step — at population scale rather than one case at a time.
The results are the reason for this session. CareSource Indiana reports 90th-percentile follow-up performance and reduced readmissions among navigated members. Leaders from the plan and its technology partner will walk through what it took: connecting plan data with hospital event notifications, structuring data sharing and accountability across two organizations and putting alerts in front of care teams without adding to their administrative load.
Learnings include:
- Where fragmented behavioral health care drives avoidable ED and inpatient use
- How AI and human navigators identify pivotal care moments and act on them at scale
- What produced 90th-percentile follow-up performance and lower readmissions at CareSource Indiana
- How the plan and its technology partner structured data sharing, governance and accountability