Payers

Why Traditional Vendors Fall Short

Community-Based Organizations

Often struggle to scale access, maintain consistent quality, and meet payer reporting requirements.

View Common Gaps

Key Gaps:

Long wait times
Limited payer quality expertise
Inconsistent clinical oversight
HEDIS and compliance challenges

Telehealth Vendors

Marketplace-based models can limit accountability, care coordination, and higher levels of support.

See Limitations

Limitations:

Marketplace clinicians with limited accountability
Telehealth-only model
No higher levels of care
Limited payer metric expertise

In-House Programs

Internal programs face overhead, staffing, and infrastructure challenges that restrict growth.

Explore Challenges

Challenges:

High overhead
Difficult to scale
Limited specialization
Staffing challenges

There's a better way.

California-focused with deep expertise in Northern California's behavioral health landscape. Proven ability to navigate California's unique regulatory environment, Medi-Cal managed care requirements, and DHCS compliance standards.

Built Differently. Better Outcomes.

Employed Clinical Teams

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We directly employ our clinical workforce, ensuring consistent standards, clear accountability, and coordinated care across your population.

Standardized clinical protocols
Direct accountability for outcomes
Coordinated, team-based care
Immediate supervision and consultation

Hybrid Care Delivery Model

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We provide a full continuum of behavioral health services, allowing members to receive the right level of care without fragmentation or external referrals.

Telehealth and in-person care
PHP and IOP programs
Interventional psychiatry (TMS, ketamine)
Same-day crisis access

Payer-Specific Metric Expertise

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Clinicians trained in utilization and quality performance.

ASAM and LOCUS/CALOCUS
HEDIS optimization (FUH, AMM, ADD, FUM)
NCQA-aligned workflows
Real-time outcomes tracking
72% FUH 7-day, 85% 30-day, and 82% same-day access rates.

Custom-Built Technology Platform

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Our purpose-built platform supports payer workflows with real-time data, seamless integration, and measurable performance visibility.

Real-time eligibility verification
Automated documentation
Custom reporting dashboards
Bi-directional system integration

The Results Speak for Themselves

Access Metrics

1.7

days

Avg. referral to treatment (vs. 42 days CA avg)

82%

Same-day urgent access

92%

IOP/PHP & interventional access

<5%

Same-day no-show rate

Quality Metrics

67%

Reduction in behavioral ER visits

72%

FUH 7-Day Performance

85%

FUH 30-Day Performance

97%

Partner satisfaction score

Cost Impact

$2.8M

Behavioral ER cost reduction

35%

FUH 7-Day Performance

3-6

months

Time to ROI

$450-850

Cost per diverted ER visit

These outcomes are possible because of our integrated model:

Employed clinicians following consistent protocols, hybrid delivery ensuring appropriate care settings, technology enabling rapid intervention, and deep payer expertise ensuring we're measuring what matters.

Northern California Health Plan Case Study

Challenge:

Plan needed to manage utilization review for 100,000+ members while maintaining quality and compliance.

Solution:

Wellity deployed ASAM/LOCUS/CALOCUS-trained clinicians with custom workflows integrated into plan systems.

Results:

Zero service disruptions during transition, improved clinical documentation quality, maintained 100% regulatory compliance, reduced authorization turnaround time by 40%.

0 service disruptions

During Transition

Reduced Autorization Turnaround Time by

40%

100%

Regulatory Compliance

Improved

Clinical Documentation Quality

One Partner.
Complete Continuum.

Your members have diverse needs. Our model delivers the full spectrum of behavioral health services under one roof, eliminating care fragmentation and referral delays.

Core Behavioral Health Services

Individual Therapy: Consistent clinical protocols and quality standards
Psychiatry & Medication Management: Board-certified psychiatrists, 3-5 day initial appointments
Group Therapy: Specialized programs (perinatal, substance use, chronic disease)
Family Therapy: Cultural competency training aligned to your populations
Crisis Intervention: Immediate clinical supervision and consultation available

Access Time:

1.7 days average, 82% same-day for urgent

Robust Case Magnement

CalAIM-Compliant Programs: Full Case management and Community Supports implementation
High-Touch Care Coordination: Dedicated care managers for complex cases
Social Determinants Support: Housing, food security, transportation assistance
Cross-System Navigation: Medical, behavioral, social services integration

Outcomes:

67% ER reduction, 35% hospitalization reduction among ECM enrollees

School-Based Mental Health (CYBHI)

On-Campus Services: Embedded counselors in K-12 settings
Early Intervention: Prevention and screening programs
Family Engagement: Culturally responsive parent workshops
Teacher Consultation: Behavioral support for educators

Impact:

Reducing academic disruption while building behavioral health literacy

Interventional Psychiatry

Transcranial Magnetic Stimulation (TMS): Treatment-resistant depression
Ketamine Therapy: Rapid-acting intervention for suicidality
Medication-Assisted Treatment (MAT): Substance use disorder programs

Differentiation:

Few vendors can deliver these higher-acuity services in community settings

Neuropsychological Assessment

Comprehensive Testing: ADHD, learning disorders, cognitive functioning
Diagnostic Clarity: Reducing misdiagnosis and inappropriate treatment
Treatment Planning Support: Evidence-based recommendations

Value:

Particularly critical for complex pediatric and adult cases

Every service is delivered by employed clinicians using standardized protocols, documented in our unified EHR, and reported through your customized dashboard. No referrals to external networks. No loss of visibility. Complete care coordination.

Partnership Models Designed for Your Needs

Whether you need a comprehensive behavioral health solution or targeted support for specific programs, we adapt our model to your requirements and timeline.

Full-Service Behavioral Health Partner

Comprehensive behavioral health delivery for plans seeking full network replacement or significant capacity expansion.

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What's Included:

Complete behavioral health service delivery
Enhanced Care Management (ECM) programs
Utilization review and authorization support
HEDIS measure optimization
Custom reporting and analytics
Dedicated account management team

Implementation:

Typically 60–90 days, depending on scope.

Targeted Program Support

Focused solutions for plans addressing specific gaps, populations, or compliance needs.

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Common Programs:

ECM implementation
School-based mental health (CYBHI)
FUH performance improvement
High-risk member interventions
Prenatal/postpartum mental health

Implementation:

30–60 days for focused programs.

Utilization Review & Quality Services

Clinical expertise for plans needing oversight and quality support without direct care delivery.

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What's Included:

ASAM/LOCUS/CALOCUS-trained reviewers
Prior authorization and concurrent review
HEDIS and NCQA consulting
Clinical documentation improvement
Appeals and grievance support

Implementation:

Operational within 30 days.

Process Overview

Step

Discovery & Assessment
(Week 1-2)

Assess population, gaps, and requirements.

Step

Design & Contracting
(Week 3-6)

Build the model and finalize setup.

Step

Launch & Integration
(Week 7-10)

Train teams and activate systems.

Step

Ongoing Optimization
(Month 3+)

Monitor performance and improve continuously.

Real-Time Visibility Into Every Member Interaction

Healthcare partnerships require trust, and trust requires transparency. Our technology platform gives you complete visibility into care delivery, outcomes, and financial performance.

Your Custom Wellity Dashboard Includes:

Member-Level Tracking

Program Performance Metrics

Operational Dashboards

Integration Capabilities

Data Security & Compliance

Proven Partnership Across California

We serve 10+ health plans across California, from large Medicaid MCOs to regional commercial payers. Here's what they tell us makes the difference:

"The difference was immediate. Our members were getting appointments in days, not weeks, and the clinical quality was consistently high. But what really impressed us was their understanding of our HEDIS pressures—they didn't need education on what FUH or AMM meant. They just delivered."

— Director of Behavioral Health, 200,000+ member Medicaid MCO in Northern California

"We've worked with multiple behavioral health vendors over the years. Wellity is the first one that felt like an extension of our team rather than an outside contractor. The real-time data access alone saves our team hours every week."

— Vice President of Network Management, Regional health plan serving Bay Area counties

"When we needed to stand up Enhanced Care Management quickly for CalAIM compliance, Wellity had a program designed and operational in 60 days. Their care managers understand the Medicaid population and the regulatory requirements."

— Chief Medical Officer, 150,000+ member managed care plan

10+

California Health Plans Served

97%

Partner Satisfaction Rate

90%

Contract Renewal Rate

669%

Company Growth over 3 Years (Inc. 5000 #67 Fastest-Growing Healthcare Company)

Inc. 5000
America's Fastest-Growing Private Companies

Let's Talk About Your Behavioral Health Strategy

What to Expect on Our Call

Duration:

30-45 minutes

Participants:

Our partnership team + your key stakeholders

Agenda:

Your current challenges and goals
Our approach and relevant case examples
Preliminary fit assessment
Next steps if there's mutual interest

Schedule a Partnership Discussion

Whether you're facing network adequacy challenges, struggling with HEDIS gaps, planning for CalAIM compliance, or simply looking for a behavioral health partner that delivers on promises—we'd welcome the conversation.

Prefer to start with our outcomes data?

Download Our 2024 Outcomes Report

Questions? Email us at

partners@wellityhealth.com

The Behavioral Health Partner

That Delivers

What Others Promise

Why Traditional Vendors Fall Short

Community-Based Organizations

Telehealth Vendors

In-House Programs

There's a better way.

Built Differently. Better Outcomes.

Employed Clinical Teams

Hybrid Care Delivery Model

Payer-Specific Metric Expertise

Custom-Built Technology Platform

The Results Speak for Themselves

Access Metrics

Quality Metrics

Cost Impact

Northern California Health Plan Case Study

One Partner.
Complete Continuum.

Partnership Models Designed for Your Needs

Full-Service Behavioral Health Partner

Targeted Program Support

Utilization Review & Quality Services

Process Overview

Real-Time Visibility Into Every Member Interaction

Your Custom Wellity Dashboard Includes:

Proven Partnership Across California

We serve 10+ health plans across California, from large Medicaid MCOs to regional commercial payers. Here's what they tell us makes the difference:

Let's Talk About Your Behavioral Health Strategy

What to Expect on Our Call

The Behavioral Health Partner

That Delivers

What Others Promise

Why Traditional Vendors Fall Short

Community-Based Organizations

Telehealth Vendors

In-House Programs

There's a better way.

Built Differently. Better Outcomes.

Employed Clinical Teams

Hybrid Care Delivery Model

Payer-Specific Metric Expertise

Custom-Built Technology Platform

The Results Speak for Themselves

Access Metrics

Quality Metrics

Cost Impact

Northern California Health Plan Case Study

One Partner. Complete Continuum.

Partnership Models Designed for Your Needs

Full-Service Behavioral Health Partner

Targeted Program Support

Utilization Review & Quality Services

Process Overview

Real-Time Visibility Into Every Member Interaction

Your Custom Wellity Dashboard Includes:

Proven Partnership Across California

We serve 10+ health plans across California, from large Medicaid MCOs to regional commercial payers. Here's what they tell us makes the difference:

Let's Talk About Your Behavioral Health Strategy

What to Expect on Our Call

One Partner.
Complete Continuum.