Does Your Health Plan Have a Challenge? MCRA Can Help!
Through collaboration, MCRA Members drive performance improvements, deliver exceptional service, transform care, and champion the health and wellbeing of the plans and communities they serve. We invite you to explore MCRA Member capabilities below. Please complete the Find Your Solution form if you would like support finding the right solution vendor(s) to support your current challenges.
Member Acquisition, Engagement, Retention & Loyalty
Maintaining membership tenure while optimizing retention and compliance is essential but challenging, especially with low-income or medically complex populations. Poor engagement can affect STAR ratings, HEDIS scores, and long-term outcomes. MCRA Members solutions support plans as they engage with hard-to-reach members, language barriers, digital divide, and SDoH factors.
HIPAA-Compliant Member Engagement
Deploy HIPAA-secure self-service member experiences for secure two-way and app-like communications — without downloads or delays. Designed for rapid, no-code deployment, health plans can easily share and gather information (including documents, signatures and payment) to streamline member journeys at scale with fast time to value—improving CAHPS, HEDIS, NCQA, Star Ratings and other key metrics, increasing accessibility, optimizing costs, and guiding customers to better outcomes.
Power Smarter, Privacy-First Member Acquisition
Bridge the gap between member privacy and digital marketing by ensuring sensitive data is never shared with non-HIPAA-compliant tools—so you can reduce cost-per-lead, improve targeting, and justify ad spend while keeping essential platforms like Google Analytics, Facebook, YouTube, and Maps active and compliant.
Data-Driven, Personalized Community-Based Engagement
Analyzing claims, quality, and demographic data to identify care gaps, community engagement specialists initiate targeted, culturally-competent conversations. Interventions delivered in peer-to-peer group settings foster trust and cohesion, promoting informed health decisions and sustained behavior change, ultimately driving better care outcomes.
Electronic Communications
Secure, timely, and targeted delivery of critical member communications via email, SMS, and digital document portals. Reduces reliance on paper mail, lowers postage and production costs, and allows for real-time tracking and delivery confirmation. Service integrates with health plan systems, ensuring personalized messaging, compliance with regulatory standards, and faster member outreach—improving engagement, reducing administrative overhead, and supporting a more agile communication strategy.
Nutrition Support that Reinforces Value
Thoughtful, high-quality nutrition during key health moments—such as after hospital discharge—enhancing the member’s sense of support and satisfaction. Offering tailored, dignified, and culturally relevant meals strengthens trust in the plan and reinforces the value of membership. Consistent, tangible support helps build long-term loyalty and engagement.
Print and Digital Communications
End-to-end management and production of compliant and time-sensitive healthcare documents for print and/or digital distribution, including: ID Cards, ANOCs, EOBs, Enrollment & Welcome Kits, Formularies & Provider Directories, plus custom outreach and health education campaigns.
Return Mail Management & Remote Mailroom
Automates receipt, sorting, and processing of returned and incoming mail. Reduces manual handling by identifying undeliverable addresses in real time, updating records, and minimizing wasted postage and re-mailing efforts. Digitizes and routes incoming documents directly to the appropriate departments or systems, accelerating response times, reducing paper handling, and ensuring regulatory compliance.
Network Development & Optimization
Ensuring access to care while maintaining a high-performing, cost-effective network is increasingly difficult. Inadequate networks harm member satisfaction, lead to CMS/state sanctions, and impact performance metrics. MCRA’s vendor organizations have the tools to optimize a plans provider network, recommending the right provider based on clinical condition and needs.
Network Quality Performance
Identifies hospitals, physicians, and outpatient providers with high-quality performance versus those contributing to unnecessary medical expenses. Through rigorous claims audits, detect overpayments and patterns of poor-quality care that increase costs and harm the member experience—helping health plans partner with providers who deliver better outcomes and value.
Provider Network Development, Contracting and Recruitment
Accelerate speed to market through targeted provider contracting, what-if scenario planning, network modeling, and dynamic reprioritization of outreach efforts. Leverage deep contracting expertise across all provider types, with a strong understanding of network requirements and market dynamics. Provide comprehensive adequacy support through geo-mapping, time/distance & provider count analysis, key health system identification, ongoing progress tracking, and early detection of adequacy risks.
Optimized & Accurate Revenue, Expense & Cost Containment
Risk adjustment models are critical for appropriate payment, but accurate coding and documentation remain challenging. With increased CMS audits, RADV enforcement, and heightened scrutiny of plans, MCRA Members prioritize effective revenue cycle management by ensuring that data collection and reporting processes are both accurate and timely. This includes robust oversight mechanisms to monitor and address all potential under- and overpayments, safeguarding compliant and optimized reimbursement.
Cost Control Programs
Deliver comprehensive reviews targeting DRGs (APC/MS), outpatient (APC), readmissions, surgical implants, observation stays, skill nursing facilities, inpatient rehabs, and high-cost outliers. Combine manual expertise with advanced, data-driven analytics to uncover hidden inefficiencies, reduce unnecessary spending, and improve patient outcomes.
Encounter Reporting and Claims
Encounter reporting & claims ingestion, validation, and outbound submission pipeline for dental, institutional & professional encounters. Supports vendor file imports for all claim types and lines of business. Built-in encounter validation, response reconciliation, and workflow management.
Medical Claims Auditing Across Care Settings
Perform comprehensive clinical, coding, and pricing audits across inpatient (MS-DRG/APR-DRG), outpatient (APC), and professional claims. Identify overpayments, recover revenue, and ensure compliance—helping payers and providers optimize medical spend while maintaining quality standards.
Regulatory Compliance & Implementation
Constant updates to CMS regulations, state Medicaid rules, and federal policy changes create administrative burdens and operational challenges. MCRA Members can support plans understanding the complexities of regulatory change and the challenges to remain compliant.
Credentialing Process Optimization
Full-service credentialing, primary source verification, and contracting with both government and commercial payers. Assessment, training, and transformation of internal credentialing processes—making overworked departments efficient, audit-ready, and future-proof.
Legal Counsel
Advice and counsel for private and public entity health plans on legal and regulatory requirements that govern their operation, licensure, and services.
Represent plans in all types of litigation, dispute resolution, and investigations with providers, competitors, and government entities.
Nutrition Program Alignment with Federal and State Standards
Nutrition program for older adults reflecting high standards of quality, safety, and compliance. Meals developed by registered dietitians and structured to align with federal and state nutrition guidelines, supporting health plans with consistent documentation, delivery verification, and program transparency.
Secure and Compliant Electronic Communications
Secure, digital platform that helps maintain regulatory compliance by automating the creation, delivery, and tracking of mandated member communications, ensuring all messages meet CMS, HIPAA, and other industry standards. Robust authentication, encryption, and audit tracking protocols safeguard member data and demonstrate proof of delivery. Supports personalized content, version control, and timestamped archiving. Integrates into existing workflows, ensuring smooth transition from paper to digital format without disrupting compliance protocols.
Automated Compliance for HIPAA, CCPA, and CMS
Enforce privacy compliance across all digital vendors and marketing campaigns by blocking unauthorized sharing of PHI/PII, logging every decision, and proving adherence to consent, data minimization, and safe downstream data use, so your plan stays compliant without manual oversight across teams.
Compliance Review & Fraud, Waste, and Abuse (FWA) Controls
Conduct targeted compliance reviews focusing on readmissions, payment integrity, and fraud, waste, and abuse (FWA) controls. Ensure health plans meet regulatory standards, mitigate financial risk, and maintain member trust by identifying improper payments, monitoring patterns of potential abuse, and recommending corrective actions.
Clinical Quality, Care Management & Whole-Person Outcomes
Improving clinical care delivery, care coordination, and health outcomes across the member population is essential. MCRA Members support traditional care management functions alongside in-home clinical assessments and whole-person interventions that address both medical and non-medical drivers of health. These services aim to improve quality performance, reduce avoidable utilization, and support members' ability to live safely and independently in their communities.
Home-Delivered Meals
Provides nutritious, expertly developed meals delivered to members during post-discharge recovery or while managing chronic conditions. Meals are crafted to meet the unique nutritional needs of older adults, supporting better health outcomes and whole-person care. Includes support to help members understand next steps when their benefit period ends, promoting continuity of care and long-term wellness.
Clinical Quality Audits & Medical Necessity Reviews
Perform comprehensive audits across DRG, APC, Skilled Nursing Facility, and Inpatient Rehab claims to evaluate clinical coding accuracy, adherence to clinical guidelines, and medical necessity. These audits identify inappropriate payments, ensure alignment with evidence-based care standards, and drive improvements in care quality and member outcomes.
Technology & Digital Innovation
Advanced technology solutions can help drive health plan efficiency, enhance member engagement, and support clinical and operational excellence. MCRA Members support the infrastructure and integration services needed to enable secure, scalable technology adoption.
AI Agents for Member Service
Empower members with AI agents that provide personalized, adaptive self-service experiences. Purpose-built for healthcare with deep domain expertise, AI agents deliver 24x7 support that is empathetic, accurate and HIPAA-secure for greater member convenience and satisfaction. Drive down operational costs and reliance on live clinical and non-clinical resources to handle routine inquiries.
Integrated Meal Delivery and Member Support Platform
Proprietary logistics and member support platform that powers efficient routing, delivery tracking, and service verification for home-delivered meals. The system streamlines operations for health plans while enhancing the member experience through consistent delivery, accountability, and flexible coordination. Real-time data helps support plan performance, utilization tracking, and care team visibility.
MCRA Members Solve Health Plan Problems
When your health plan has a challenge, MCRA can help connect you with the right company or team of companies to address the challenge and offer innovative and tailored solutions. Complete the short form below and MCRA will facilitate an introduction to the MCRA Members(s) who may be able to assist.
Not sure what solutions you need? We can schedule a complimentary discovery call with one of our strategic advisors to help assess your current challenges and how MCRA can support your needs.
Our Collaborative Approach
“MCRA Members are creative, innovative and proactive in both business development and relationship building. Our collaborative approach enhances industry knowledge, trends, and pain-points for Members. The partnerships being developed provide deeper solutions that address today's Health Plan challenges." — Barry Volin, MCRA CEO & Co-Founder
