AbsoluteCare’s Vision for Medicaid & Medicare Advantage Care Innovation in 2026
By Mike Radu, CEO, AbsoluteCare
The Moment of Truth for Medicaid: Why We Must Innovate Now
Medicaid plans across the country are at a true crossroads – one shaped not just by rising costs, but by structural shifts that are fundamentally reshaping who Medicaid serves. The unwinding of the Public Health Emergency (PHE) has accelerated redeterminations and pushed millions of healthier members off the rolls, concentrating risk among those with the highest and most complex needs. And the pressure isn’t easing. More frequent eligibility checks – moving from annual to semi‑annual – and the introduction of new work requirements are intensifying churn, further eroding the stability of the risk pool.
The result? Enrollment may be plateauing or even declining, but acuity is rising sharply. What that means in practical terms is that the members left in the risk pool are those with the most complex, multidimensional needs. Behavioral health challenges, deep rooted social determinants of health (SDoH), and the consequences of fragmented care are driving higher utilization, higher spend, and needs that traditional models were never designed to manage.
At AbsoluteCare, we see this not as a crisis, but as a call to action. While Medicaid systems across the country are cutting funding and scaling back services, we are doing the opposite. In 2026, we are expanding our Community teams and capabilities by more than 300% – a deliberate investment in what matters most: engaging the hardest‑to‑reach members, strengthening transitions of care, solving behavioral health fragmentation, and addressing the social needs that drive preventable spend.
Our vision goes Beyond Medicine™ because health isn’t just about clinical care. It’s about meeting people where they are, tackling the root causes of poor outcomes, and creating a system that truly serves the whole person. We’re not just tweaking old programs; we’re reimagining the future of care for Medicaid and Medicare Advantage D-SNP and C-SNP members, proving that the path forward requires leaning in, not pulling back.
Four Innovations That Set AbsoluteCare Apart
1. Expanding Community Care Model: Engagement to Results
We’re reengineering – and growing – our community care teams to connect with members who rarely engage in traditional primary care, especially those attributed to our wraparound network PCP model. What’s new?
- Smaller, regionally aligned teams with clear accountability
- More field-based outreach and expanded home-visiting capacity
- Behavioral health, pharmacy, and SDoH specialists supporting community teams
- Flexibility to meet members where they are: home, hospital, or community
Why does this matter? Because it means higher engagement among members historically labeled “unable to reach,” more stable PCP activation, and reduced avoidable ED use tied to unmanaged chronic and social needs. Our network PCPs get better coordination and improved performance on HEDIS and STARs measures. This is real, measurable impact.
AbsoluteCare by the numbers: By the second month after implementation of the expanded community model, we increased successful engagement contacts with community members by 20%.
2. Transitional Care, Reimagined: Meeting Members at the Bedside
Breakdowns during care transitions are among the costliest, but preventable, drivers of utilization. In 2026, we’re expanding our transitional care model to intervene earlier, right at the bedside.
- Face-to-face engagement at admission and discharge
- Immediate scheduling of 7-day follow-up visits (in office or provider visits to member’s homes)
- Rapid medication reconciliation with integrated pharmacy support
- Coordinated post-discharge follow-up from CHWs and behavioral health clinicians
The result? Higher 7-day and 30-day follow-up compliance, meaningful reductions in readmissions, lower ED utilization in the 90 days post-discharge, and better stabilization of high-risk, high-cost members during vulnerable transitions.
AbsoluteCare by the numbers: In a new patient population, we saw 70% of hospitalized members face to face. Over the first 6 months after enrollment, we increased the rate of hospital follow-up visits by 50%.
3. Solving Behavioral Health Fragmentation: Integrated SMI & SUD
Behavioral health fragmentation, especially for members with serious mental illness (SMI) and substance use disorder (SUD), remains one of the toughest challenges for Medicaid plans. Our integrated SMI/SUD model brings primary care, psychiatry, SUD treatment, and community supports together under one clinical home.
- Expansion of integrated SMI/SUD clinics across all markets
- Increased adoption and monitoring of long-acting injectable (LAI) antipsychotics
- Hybrid care model blending Assertive Community Treatment (ACT) model intensity with Collaborative Care model scaling and measurement
- Full integration of medical, psychiatric, and social supports
What does this mean for payers? Fewer behavioral health-driven ED visits and psychiatric admissions, improved medication adherence, reduced cycling through EDs, hospitals, and shelters, and stronger performance on behavioral health HEDIS measures. As well as, lower total cost of care among the top 5–15% of utilizers.
AbsoluteCare by the numbers: In treatment of Schizophrenia, we have increased the use of LAI antipsychotic medications by 50% over the baseline. Among members for whom LAIs are clinically indicated, nearly one in four receive them upon joining AbsoluteCare.
4. CKD: Meeting Members’ Needs and Connecting Providers
Chronic Kidney Disease (CKD) is a silent driver of cost and complexity, often compounded by social barriers and fragmented care. In 2026, we’re expanding our Beyond Medicine™ approach to CKD with a high-touch, integrated program designed to slow disease progression and ensure timely dialysis initiation for those who need it most.
- Proactive engagement through early identification and enrollment into CKD care pathways, starting with SDoH interventions to build trust and remove barriers.
- Evidence-based therapies such as SGLT2 inhibitors, RAAS blockers, and statins to improve outcomes and delay progression.
- Connected care infrastructure with digital workflows and KPI dashboards that enable continuous monitoring and coordination across PCPs, nephrologists, and dialysis centers.
Expected results? This proactive, integrated care model is designed to reduce CKD-related hospitalizations and complications, improve medication adherence, and stabilize disease progression. Ultimately translating into a lower total cost of care for high-risk CKD populations, creating better outcomes for members and stronger value for payers.
AbsoluteCare by the numbers: Our model demonstrates clear outcomes for CKD members, including a 54% delay in the start of dialysis (compared to a pre-test group), reduction for inpatient admissions and ED visits by 13% and 15% respectively, and a Strong Start Program resulting in decreased hospital dialysis initiation by 40%.
Setting the Stage for Partnership
For 25 years, AbsoluteCare has been redefining what it means to care for the most vulnerable, and in 2026, we’re taking that commitment even further with innovations that sharpen and align our proven capabilities to what Medicaid and Medicare Advantage plans need most.
We’re focused on driving higher member engagement, reducing preventable utilization among the most vulnerable, strengthening behavioral health integration, and improving quality and outcomes at scale.
We know the challenges are real, but so is our passion, and our track record, for solving them. Where others are trimming supports, AbsoluteCare is scaling what works – delivering a 20% reduction in total cost of care, double‑digit drops in hospital and ED utilization, and moving quality from the 25th to the 75th percentile – all while sustaining an NPS of 76.
If you’re looking for a partner who brings fresh thinking, unmatched innovation, and decades of experience, let’s talk. Together, we can build a future where every member receives the care, support, and dignity they deserve.
Ready to learn more? Connect with AbsoluteCare at mcroasdale@absolutecare.com to discover how we’re redefining what’s possible for Medicaid and Medicare Advantage members in 2026 and beyond.