The challenge
Kern Health Systems (KHS), a managed care health plan headquartered in Bakersfield, California, serves recipients of Medi-Cal, California’s Medicaid program for low-income individuals in Kern County. During the pandemic, there was a rapid increase in Medi-Cal members as employees cycled off their company-sponsored healthcare and state eligibility guidelines relaxed. In addition to KHS’s growing claims volume, the plan needed to meet state regulatory requirements to develop alternative payment model (APM) programs in support of its Medi-Cal business. California regulatory mandates require KHS to create new provider contracts quickly. However, the plan’s growing number of claims led to more time-consuming manual work and the need for additional resources to handle the increased claims. To tackle these challenges, KHS needed a partner that was more than just a vendor, so the plan turned to Cognizant.