Dr. Urmesh Shah: Ensuring Optimized Care to Help People Make Strides Along Their Health Journey

An avid runner, Dr. Urmesh Shah takes steps each day to stay healthy. Long-distance running, as well as traveling and meditating, are activities that help him stay inspired, grounded, and refreshed. In his role as regional vice president within Medicaid clinical operations, he’s focused on helping members make strides on their own health and wellness journeys.

Shah leads the clinical teams for Elevance Health-affiliated health plans in multiple states. He and his team perform vital care management functions to ensure members receive high quality and appropriate care and support specific to their needs. Their strategies to drive improved health outcomes include analyzing clinical data and identifying patterns in how a member uses healthcare services — this insight helps inform opportunities to optimize care for each member. They also evaluate the effectiveness and efficiency of care and help develop and coordinate care plans to best meet a member’s unique circumstances.

“We consider the whole health needs of each member in the work we do, routinely identifying and addressing the health-related social needs  that impact their ability to achieve optimal health outcomes,” Shah said.

What was a fulfilling moment when you knew your work had a positive impact on our members?

Hepatitis C, a viral infection that affects the liver, has historically been a chronic, life-long struggle for people with this disease. Thankfully, there are now curative treatments available which not only improve quality of life, but also can prevent the need for liver transplants in the future. We recently recognized that many of our members with Hepatitis C were not obtaining or completing these therapies. Many states impose strict regulations before allowing members to seek coverage for these medicines, and some members refuse to seek treatment due to the stigma they feel from having this condition. I work on an initiative in which our case managers carefully help many of these members access their care, coordinate the steps necessary to initiate and complete treatment, and track follow-up testing. The program has been extremely impactful, as measured by the number of members with Hepatitis C completing their treatment and the corresponding reduction in their need to use hospital and emergency room services.