Clinical Model

Personalized medical and behavioral health
support for better health outcomes.

Deep Clinical Model, Coordinated with Providers

Imagine the power in having an independent team of nurses, doctors and clinical specialists providing personalized, evidence-based support for each of your members, regardless of condition, acuity, or stage of care. Preparing them for visits and procedures. Coordinating with providers to close gaps in care. Applying principles of behavioral science to influence members to make the best healthcare decisions. It’s what drives better compliance and better outcomes, both health and financial.

Multidisciplinary Clinical Expertise

Working in lockstep with Accolade Health Assistants is our team of doctors, nurses, behavioral health clinicians, pharmacists, social workers and clinical leaders. Members of the Accolade clinical team typically hold multiple advanced degrees and bring decades of experience in their areas of specialization, including emergency medicine, oncology, obstetrics, diabetes, behavioral health, pediatrics and many others.

Provider Coordination

Our clinical team works closely with providers and nurses to optimize care for our members. With robust data profiles on each member and their benefits, we manage communication among doctors, nurses and other caregivers, coordinate care, address contextual barriers, close gaps in care, improve compliance, and ensure continuity across care settings.

Whole Population Care

Most high-cost patients weren’t in that category the prior year. That’s why we engage the entire population early and often – before or just as members are starting to think about seeking healthcare. This means we can provide more coaching, planning and guidance to influence decisions and help people get the right care at the right time – before they become high-risk, high-cost patients.

Whole Person Care

Workplace pressures, financial challenges, behavioral health issues and other life factors play a significant role in a person’s health and ability to get effective care, but physicians take contextual issues into account less than 60% of the time. Accolade goes home with the patient, supports them where they live, work, play and pray, and uncovers and addresses barriers to care that improve health and financial outcomes.

Integrated, Accredited Care Management Programs

Our integrated care management programs are at the center of our total health management approach for the members we serve. Unlike traditional care plans that treat each condition separately, Accolade offers integrated clinical services and programs that put the member at the center of care, providing consistent support to promote compliance and optimize self-management skills.

Case Management

Accolade has earned accreditation from the prestigious National Committee for Quality Assurance (NCQA) for Complex Case Management, Maternity Case Management, Neonatal Intensive Care Unit (NICU) Case Management, and Oncology Case Management services. NCQA case management accreditation demonstrates that programs are dedicated to care coordination, patient-centeredness and improving quality of care.

High-Cost Claimants

Accolade gets in front of the healthcare decisions of potential high-cost claimants before they reach the high-cost claimant threshold. Rather than wait for a UM request – when a care decision has already been made and it’s too late to influence care paths — we proactively identify prospective high-cost claimants before diseases or conditions reach advanced stages, providing support so that we can help them achieve better outcomes and cost savings.

Disease Management

Accolade supports members with any chronic condition – including obesity, diabetes, cardiovascular care and cancer – through a holistic approach that focuses on medical, behavioral, contextual, financial and other aspects of the individual – not just their condition. A dedicated nurse works closely with the member and their provider to develop collaborative care plans, coordinate care, uncover contextual factors impacting care, and ensure the member’s needs are being met.

Nurse Triage

Accolade provides 24 x 7 nurse triage services, helping members who are experiencing health symptoms get to the right care, prepared to ask the right questions of providers. Our nurses educate members on care options and benefits, assist them in determining when emergency care is necessary, support them in finding providers and removing barriers to care, and follow-up post visit as appropriate.

Rx Support

Accolade supports members with all of their medication and pharmacy benefit needs, with a focus on medication adherence and compliance. Our nurses work with members to ensure they understand each of their medications and how to take them, as well as the importance of taking them as prescribed. We identify and resolve any barriers that foster non-compliance.

Maternity

Once enrolled in our maternity management program, members, regardless of risk level, receive comprehensive support before and during pregnancy and after delivery to improve pregnancy outcomes, decrease NICU admissions and reduce costs associated with complications. Infertility and NICU nurses are a key part of our women’s health team.

Pre-Admission and Post-Discharge Support

Accolade supports members in preparing for an inpatient stay and complying with their post-discharge treatment plan, with a focus on helping them avoid unnecessary extended length of stays and readmissions. Our nurses educates members on what to expect during treatment, ensures they understand the recovery process – including treatment and medication – and addresses potential barriers to receiving care post-discharge.

Treatment Decision Support

Accolade provides 24 x 7 nurse triage services, Accolade identifies members who are making treatment decisions and provides them with the information they need to partner effectively with providers and make the best healthcare decisions. Our nurses provide evidence-based medical information and help members assess the pros and cons of any specific treatment in the context of their lives and values.

Behavioral Health

Accolade’s integrated medical behavioral model is effective in addressing the behavioral health needs that often drive medical costs. Our Behavioral Health team supports members with primary or comorbid conditions, including depression, anxiety, substance abuse and psychiatric illness. They work with our medical nurses and their members in assessing needs, finding providers, coordinating care, and helping members understand their behavioral health treatment options.

Delivering Exceptional Results

By engaging early and over time, focusing on the whole person, resolving barriers to care and influencing providers, Accolade delivers exceptional results:

40%

CASE MANAGEMENT

Accolade enrolls 40% of members into case management, compared to 5% enrollment in traditional health plans.

90%

HIGH COST CLAIMANTS

Accolade influences care decisions of 90% of high cost claimants before they reach the HCC claim threshold.

60%

BEHAVIORAL HEALTH

Accolade assists more than 60% of members with behavioral health comorbidities.

9%

CLINICAL SUPPORT

Accolade drives a 9% increase in prescription refills and 93% medication compliance.

64%

MATERNITY ENGAGEMENT

Accolade engages 64% of pregnant women in the first trimester, reduces NICU stays 6.5 days per 1000, and reduces the number of preterm births and low birth weight babies by 30%.

23%

HOSPITALIZATION

Accolade nurses call each member scheduled for hospitalization and post-discharge, reducing inpatient days by 23%.

The Accolade Experience

My Accolade nurse admin. is super. She has helped me so much to keep my health up to great standards - finding programs for my specific needs. This is the best care I’ve had. My nurse is awesome, love her. She knows how to help me. I am so grateful.
Lowe's employee