Care Management

Combining actionable insights with clinical expertise to help members navigate their healthcare journey, improve care quality and control medical costs.

Gather, assess and coordinate member health needs to encourage cost-effective preventive care and reduce costly gaps in care. We focus on member engagement with compassionate and intelligent outreach that fosters continuity of care between members and the providers treating them.

With medical spend on the rise and ever-changing regulations, you need a partner to help educate and engage members throughout their healthcare journey, while optimizing costs. Through our proprietary analytics, comprehensive data and leading decision technology, we help payers build a 360-degree view of members, including socio-economic demographics, behaviors and medical risks. Through a holistic member picture, we improve outcomes by targeting high-cost populations, triggering care coordination interventions, and educating members on how to navigate the complex healthcare system and use their benefits accurately.

Care Management Benefits:

  • Reduce unnecessary utilization

  • Reduce medical costs

  • Improve risk scores and STAR ratings

  • Increase member engagement

  • Stratify member populations

  • Enhance member healthcare decisions

Health Risk Assessments

Our intelligent HRA allows you to know and engage your members up-front to gain a complete picture of your population’s health risks, so you can stratify interventions and deliver better health outcomes.

Care Coordination

Sorting through the multiple providers, services and claims found in a health plan can be confusing and time-consuming for members. Leveraging a concierge approach, our experienced member advocates provide unbiased support to help your members navigate barriers and concerns regarding their healthcare needs, ultimately improving member retention, preventive care and reducing cost.

Nurse Health Line

This 24-7 service offers members immediate toll-free access to Registered Nurses who offer advice using evidence-based guidelines. It also provides Rapid Triage Screening to quickly identify and respond to serious health issues, helping members make informed healthcare decisions and avoid unnecessary emergency room visits.

Utilization Management

We support prospective, concurrent, and retrospective reviews to help ensure appropriate, cost-effective and medically necessary member care. Our experienced nursing staff fosters person-centered engagements without disrupting day-to-day continuum of care and leverages nationally recognized guidelines to evaluate medical necessity.

Case Management

We identify high-risk, high-cost members and provide collaborative care planning across their healthcare team to reduce unnecessary utilization and cost, while enhancing outcomes. Care managers coordinate care across providers throughout the care continuum, helping health plans avoid hospital admissions, ER visits and medical complications by educating members and proactively monitoring their progress.

Chronic and Disease Management

We help target members with chronic health issues who are struggling to manage all their health needs. Better self-management makes a difference in quality of life and outcomes, but often barriers such as a limited provider access, poor healthcare literacy or social determinants of health can block progress. Through care coordination and education, we support and empower members to make healthier choices that improve their health, limit their risk of complications and reduce medical costs.