The Health Plan Challenge

For health plans, case management is more complex than ever. Members often present with multiple comorbidities, social needs, and behavioral health challenges — all of which increase costs when left unmanaged. At the same time, CMS mandates, HEDIS Social Needs Screening (SNS-E), and new G and Z Code requirements are raising the stakes on compliance and reporting.

Beyond managing individual cases, plans also face the challenge of building, credentialing, and maintaining networks of community-based organizations (CBOs) that can address members’ social determinants of health (SDOH). Doing this at scale requires more than a directory — it requires a connected ecosystem.

How Wellup Supports Health Plans

Wellup’s platform was designed to meet these needs head-on. By combining case management workflows, automated compliance tools, and network management capabilities, Wellup gives health plans a scalable foundation for success:

• Streamlined Member Onboarding
  Health plans can quickly capture SDOH data through mobile-friendly assessments that generate Z Codes automatically.
• Integrated Case Management
  Case managers use a single platform to track medical, behavioral, and social needs — with navigator workflows built to manage complex members longitudinally.
• Closed-Loop Referrals
  Plans can ensure members are connected to CBO partners for food, housing, transportation, and other services, while tracking referral outcomes to prove impact.
• Network Development & Credentialing
  Health plans can manage a growing ecosystem of community partners, with credentialing, contracting, and performance tracking all built into the platform.
• Compliance and Reimbursement
  Automated workflows support CMS mandates, HEDIS SNS-E reporting, and accurate G Code billing for social care services delivered to members.

Case Study in Action: Lowering Total Cost of Care

Wellup helps case managers better support high-cost, high-need members who are frequent users of emergency departments. By connecting members to housing and behavioral health services through Wellup’s credentialed CBO network, the plan can acheive:

• Reduction in ED Utilization among targeted members within the first year.
• Improved Compliance Scores by meeting CMS reporting mandates for SDOH documentation.
• Network Growth with over 200 credentialed CBO partners onboarded and managed through the platform.

The result was a healthier member population, reduced costs, and stronger performance in value-based care contracts.

The Path Forward for Health Plans

As the industry shifts toward value-based care, health plans need more than claims data — they need actionable insights into the social and behavioral drivers of health. With Wellup, plans can transform case management and network operations into a scalable, compliant, and outcomes-driven system that lowers costs and improves member well-being.