Case Study: Large Regional U.S. Health Plan boosts reporting, engagement, and star rating with EXL CareRadius

CareRadius™ platform fully integrates and automates workflows

EXL worked with a large regional U.S. health plan serving more than 600,000 members and multiple audiences, including employer groups, regulators, and healthcare providers. The health plan’s care management processes were spread across disconnected applications, making it difficult to get a full member view, streamline workflows, and quickly produce accurate reports for employer and regulatory needs.

EXL implemented its CareRadius web-based care management platform to integrate disparate data sources, automate workflows, and enable self-configured reporting and case management. As a result, the health plan cut report turnaround from one year to one day, raised member engagement from 30% to 70%, reduced CMS audits from 1.5 months to three days, improved NCQA case management audits to one day, increased its CMS star rating from 3 to 4.5, and reduced behavioral health readmissions by 15% and medical readmissions by 20%.