Payer Overview
Diverge partners with primary care providers in your network to deliver high quality care and lower costs for Medicaid patients.
Why Partner with Diverge?
25% of primary care providers manage 86% of Medicaid patients. Diverge partners with these providers with administrative support to close quality gaps and clinical support to educate high risk patients on their chronic conditions, reducing overall cost of care.
Our Support Model
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Care Solutions
Health Coaches, NPs, and social workers act as an extension of care in the community. The health coach model has a decade of proven results, and health coaches are trained in motivational interviewing techniques to educate patients on their chronic conditions.
Our behavioral health program uses the collaborative care model, allowing patients access to behavioral health support from the comfort of their primary care office.
Diverge also has a number of point-of-care solutions available in new markets, such as transitions of care and ER Diversion, with more being added every year.
Proactive Panel Management
Our provider liaisons leverage technology and data to help optimize routine care of Medicaid patients, including pre-visit planning and post-visit documentation workflow. For high-risk patients, we conduct timely outreach and EMR chart reviews to help develop care plans.
Data Reporting
We deliver insights through analyzing relevant data to help providers manage quality and financial performance. Practice liaisons will deliver these insights regularly to support gap closures and identify areas to improve our partnership, model, and performance.
Standardized Value-Based Contracts
Diverge helps to streamline activity across your Medicaid payer partners and provide access to attractive value-based contracts. Providers bear no risk, pay no fees, and have a single set of goals to meet. No more juggling the demands of different payers.
Aligned Economic Incentives
Our contracts prioritize patient outcomes and align incentives accordingly, providing high-quality care to Medicaid patients. Preventive care, health coaching, and gap closures allow both Diverge and payer partners to participate in shared savings and bonuses.
Who Benefits and How:
Payers
- Enhanced performance on state APM, quality, and health equity requirements leading to enhanced RFP bids / positioning with states
- Revenue enhancement, and consistent, higher gross margins
- Network independent primary care physicians can stay independent
Primary Care Providers
- Access to community health teams and practice liaisons to augment patient care
- Access to technology, data, and clinical workflows – one system across payer partners
- Incremental revenue through gain share and provider incentives
Patients
- Access to community health teams who can meaningfully improve access, health literacy, and overall patient health
- Improved outcomes and better quality care experience addressing both clinical and non-clinical needs
Proven Outcomes
The Diverge Model works for providers and their patients, reducing care costs and creating better health outcomes.
$14,900
reduction in cost for patients enrolled for 1 year in Diverge programs
50%
reduction in ER admissions for health coaching patients with asthma
86%
reduction in inpatient costs for patients reaching key milestone in health coaching journey
Patient Impact – Case Studies
At Diverge Health, every patient’s story is a testament to the power of comprehensive, community-driven healthcare. These stories of real individuals reflect the challenges that many underserved populations face daily, from chronic conditions to health system barriers.
Mary, 57
Diabetes, Chronic Kidney Disease, Hypertension, and Severe Back Pain
View Case Study
Mikal, 49
Hypertension, Obesity, Hyperlipidemia, Foot Pain, and Depression
View Case Study
Pam, 55
Hypertension, Anxiety, Depression, and Insomnia
View Case Study