Case Studies - InnovaCare Health
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Case Studies

We have a 20-year track record of finding opportunities to create sustainable healthcare ecosystems in difficult markets.

When we entered Puerto Rico by acquiring MMM Healthcare in 2006, we inherited a health plan that lagged behind its mainland competitors in terms of technology, efficiency and financial solvency.

By leveraging InnovaCare’s deep expertise in payer-provider dynamics, we:

  • Streamlined contracts, analytics and physician incentives to achieve the quality, cost and utilization metrics today’s market demands.
  • Built and retained a satisfied membership base, with perks incentivizing patients to take control of their health
  • Maximized contracts with pharmacy benefit managers (PBMs) to manage drug prices for a high-needs population.
  • Invested in evidence-based programs to keep patient populations well – not only heal them when sick.
  • Developed and engaged physician networks through our best practices and proprietary technology.

We did all of this successfully, despite the challenges unique to serving a highly dual-eligible population. Today, MMM Healthcare is one of the most trusted and largest federal health plans in Puerto Rico. More importantly, it’s the only plan on the island to receive 4.5-star quality rating from the Centers of Medicare & Medicaid Services (CMS). The system has grown substantially – over the past ten years, revenues have increased by almost 300 percent – all while maintaining an average member satisfaction rate of over 90 percent.

Our company specializes in treating chronically ill patients – traditionally the most expensive, difficult-to-treat patient population.

Specifically, we’ve recently tackled the two factors that drive up costs: high utilization and frequent visits to the emergency department.

We began by reviewing comprehensive data for the 250,000 members of one of our Medicare Advantage plans. After a thorough analysis, we identified 6,600 chronically ill members who frequently visited local emergency rooms. In total, the annual healthcare costs for these members added up to $270 million.

Much of this cost was due to a lack of coordinated care and patient education. In response, InnovaCare launched and expanded VitaCare, a chain of clinics that provide specialized care for high-cost and high-risk chronically ill patients.

With thousands of members now regularly visiting VitaCare clinics, the cost of caring for these patients has declined along with the frequency of ER visits. Already, our VitaCare program has cut healthcare costs for these 6,600 members by millions.

The success of these clinics stems from InnovaCare’s dedication to quality, which we demonstrated through:
• using a multidisciplinary team to coordinate care;
• improving transparency and information-sharing;
• integrating behavioral services with specialized chronic care; and
• and educating members, empowering them to take ownership of their health.

Meet our Subsidiary: Vita Care
Vita Care clinics represent a one-stop treatment program for members seeking to improve and control their chronic conditions. Through multidisciplinary teams, our trained specialists coordinate care and close gaps; improve documentation and medication adherence; educate and empower members to take ownership of their conditions; and integrate behavioral services with the specialized chronic care these individuals need.

Electronic connectivity and communication are vital to effectively managing population health.

Luckily, they have been a cornerstone of our company for the last 20 years.

We continually invest in creating and implementing market-leading technology. Over the years, we have fine-tuned our proprietary products and systems to create digital channels for physicians and stakeholders to share best practices, coordinate care and identify opportunities to cut unnecessary costs and incentivize quality outcomes.

Some of our unique data analytics products include:

InnovaMD, a provider-focused system built on a Health Information Exchange that includes a care dashboard that provides physicians with an integrated platform to coordinate care and prevent acute medical events.

SmartPaper and Quality Improvement Monthly Statements (QIMS), two documentation products that help providers understand actionable opportunities to improve outcomes. These tools enhance our physicians’ ability to coordinate care through a deep analysis of factors including beneficiaries’ health conditions, previous treatments and medications.