Guided Care Management partners with Texas Medicaid health plans to deliver targeted case management for high-risk pregnant women, children with complex needs, and populations requiring HHSC-compliant coordination.
Managing high-risk Medicaid populations in Texas is getting harder — not easier. Here's what our partners were facing before they chose GCM.
Texas has one of the highest maternal mortality rates in the nation. High-risk pregnant Medicaid members face the greatest risk — and health plans are accountable for closing that gap.
STAR Kids and CSHCN populations require coordinated, multi-agency care that internal teams rarely have capacity to deliver at the intensity these members need.
Audit findings, corrective action plans, and STAR rating penalties are rising for plans with gaps in case management documentation, outreach, and follow-up compliance.
Prenatal, postpartum, and well-child HEDIS measures are under scrutiny by HHSC — and poor scores directly threaten contract renewals and performance incentives.
We are not a software platform. We are a dedicated team of clinically trained care managers embedded in Texas communities — working the hardest cases so your team can focus on scale.
High-risk prenatal identification and outreach, postpartum follow-up coordination, and HEDIS prenatal/postpartum care measure compliance — built for Texas Medicaid's most vulnerable members.
STAR Kids, CSHCN, and foster care coordination including multi-agency care planning, behavioral health integration, school coordination, and caregiver support for children with complex needs.
Audit-ready case management files, HHSC Uniform Managed Care Contract adherence, and documentation standards designed to protect your plan during every regulatory review.
Culturally competent, multilingual outreach to hard-to-reach Medicaid members across all Texas service areas — including high-risk OB, pediatric, and dual-eligible populations.
Targeted interventions driving improvement on prenatal care initiation, postpartum follow-up, well-child visits, and behavioral health follow-up measures critical to your STAR rating.
Transparent monthly performance reporting tied directly to your KPIs, HEDIS targets, STAR ratings, and HHSC contract requirements — with no surprises at audit time.
GCM is qualified and experienced across the full spectrum of Texas Medicaid managed care programs.
These Texas Medicaid plans trust Guided Care Management with their highest-risk, highest-need populations.
STAR · STAR Kids · STAR+PLUS
STAR · STAR+PLUS · STAR Kids
STAR · CHIP · Medicaid
STAR · STAR Kids
STAR · STAR Kids · CHIP
Our teams know HHSC Uniform Managed Care Contract requirements inside and out. Your documentation holds up during audits — every time.
We are in the communities your members live in — culturally competent, multilingual, and locally connected in ways national vendors cannot replicate.
Supplement your internal team for high-complexity cases, or contract a full program. We scale to your membership size, service area, and operational needs.
No lengthy ramp-up required. Our teams are trained, credentialed, and ready to begin serving your members faster than any internal build-out.
Real-time reporting tied to your specific KPIs, HEDIS targets, and HHSC contract requirements. No black boxes — full visibility, always.
WellPoint, UHC, Parkland, Aetna, and Cook Children's trust us with their most complex populations. We know what Texas plans need and how to deliver it.
A clear, proven partnership model that gets your members supported quickly.
20 minutes to understand your population, programs, and priority gaps.
We review your current case management performance against HHSC standards.
We co-design a case management model built for your specific membership.
Credentialed care managers begin member outreach and case assignment.
Monthly performance reporting and continuous improvement tied to your KPIs.
Three ways to take the next step with Guided Care Management.
Whether you're exploring a new partnership, looking to expand an existing relationship, or simply want to learn more — our team is ready to connect. No pressure, no pitch. Just a real conversation about how we can help your members.