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9 Care Management Platform Must-Haves for Payers

Too many obstacles stand in the way of implementing a person-centered model of care. Complex workflows. A lack of coordination among medical, behavioral and community health organizations. Inadequate partner and patient engagement. No access to real-time, actionable data. An inability to identify gaps in care. And more.

If your organization strives to improve member health outcomes and better manage costs, these are the 9 care management platform must-haves:

  1. Deep Clinical Expertise

Robust understanding of clinical operations, regulatory compliance and technical aspects of the business, bridging the clinical and technical is critical.

  1. Leading Innovations

Market-leading capabilities enable the most complex clinical models today, with significant investment and growth toward composable digital health solutions.

  1. Ease of Integration

An out-of-the-box integration suite facilitates easy connectivity across your vendor ecosystem for lower costs and better member outcomes.

  1. Operational Efficiency

An advanced rules engine and user-friendly workflow capabilities automate business processes to streamline operations.

  1. Reimagined Implementation & Upgrades

Using the latest technology innovations makes it easy for payers to incorporate standard new functionality and innovations frequently and easily for a lower cost.

  1. Resiliency to Change

Highly configurable features and workflows enable payers to embrace change, stay competitive, and take advantage of opportunities created by a variety of market dynamics.

  1. Actionable Insights

Near real-time business intelligence arms your leaders to make informed key operational and clinical decisions.

  1. Regulatory Support

Managing the ever-evolving state and federal requirements so you can stay compliant while improving member engagement and satisfaction, STAR ratings, health outcomes, and more.

  1. Security & Compliance

HITRUST certification is a must to reinforce robust enterprise compliance and security safeguards.

HealthEdge’s GuidingCare

The GuidingCare suite of solutions enables health plans to support care management, utilization management, appeals and grievances, authorizations, and population health in a next-generation, fully integrated platform. The unique solution enables digital payers to transform care management by improving mission-critical workflows and delivering access to real-time data that drives superior financial and health outcomes. Learn more here.