Care Management
Every review, every case and every interaction reflects a real person navigating a real health challenge. State Medicaid agencies face growing pressure to improve outcomes and coordinate care across fragmented systems, even as needs grow more complex and resources stay limited. Comagine Health® helps states modernize care delivery so members get timely, person-centered care and programs perform sustainably.
Our care management work connects clinical expertise, data insight and real-world patient engagement. We work directly with individuals, providers and state programs, not just at the system level, across utilization management, case management and care coordination in both waiver-based and fee-for-service environments.
Core Solutions
Where this work takes shape
Utilization Management
Ensuring appropriate, timely and evidence-based care.
Appropriate care works when decisions are consistent, timely and grounded in clinical evidence. We help states and delegated partners ensure members receive the right care in the right setting while reducing unnecessary administrative burden on providers.
How We Help
- Apply consistent, evidence-based medical necessity criteria across physical and behavioral health using licensed nurses, behavioral health clinicians and physician reviewers
- Improve prior authorization efficiency and decision timeliness
- Support continued stay, discharge and appeals and fair hearing reviews
- Strengthen program integrity and regulatory compliance
- Incorporate social drivers alongside clinical criteria for whole-person decisions
Case Management
Helping individuals navigate complex health care.
People with complex needs often face fragmented systems that are difficult to navigate without coordinated support. We provide personalized, patient-centered care management that improves outcomes by connecting individuals to the right services and reducing barriers to care.
How We Help
- Develop individualized, whole-person care plans
- Coordinate across clinical, behavioral and social service systems
- Address barriers to care, including social determinants of health
- Engage members and families through interdisciplinary care teams, including nurses, behavioral health clinicians and care coordinators
- Improve outcomes through continuous feedback and adjustment
Care Coordination
Strengthening system-wide connections.
Care breaks down when services, providers and supports operate in isolation. For states seeking more targeted support, we offer focused care coordination as a standalone option, connecting providers, community resources and services without the full infrastructure of case management.
How We Help
- Align services across Medicaid, behavioral health and social supports
- Improve continuity of care across systems and transitions
- Strengthen communication across care teams and agencies
- Support HCBS, waiver and integrated care models
- Reduce fragmentation without adding provider burden
Selected Work
Recent engagements
Strengthening rural care coordination and system alignment
Through the Alaska Medicaid Coordinated Care Initiative, we provide in-person, one-on-one case management for members with high emergency room use, helping them navigate the health system and access the care they need.
Coordinating person-centered behavioral health care
Through the Oregon Behavioral Health Support Program, we connect adults with severe mental illness to resources and support coordinated, individualized care planning across providers and services.
Delivering tailored care and support for employer populations
For employers such as Northwest Plumbing and Pipefitting and Puget Sound Electrical Workers, we provide utilization review to help members get the right care at the right time.
How we work
Neutral Convener
Trusted by agencies, providers and communities
Data-informed partner
Using evidence to guide decisions and identify patterns
Community-rooted collaborator
Grounded in local context and relationships
Clinically rigorous
Deep experience serving high-need populations
Scalable and adaptable
Able to support programs across settings and states
Related Practices
Explore the practices behind this work
Let's improve care for the people who need it most.
Looking to strengthen care management or improve outcomes for high-need populations?