Leveraging AI to Summarize GuidingCare Notes and Empower Care Managers

In today’s healthcare environment, care managers are at the heart of improving outcomes for members with complex needs. Yet, the growing volume of documentation, assessments, and free-text notes often shifts their focus away from direct member engagement. We see firsthand how health plans are searching for ways to reduce this administrative burden while ensuring accuracy, compliance, and personalized care delivery.

At HealthEdge®, we believe artificial intelligence (AI) is a powerful tool to meet these demands. By embedding AI directly into care management workflows, we can accelerate information processing, identify actionable next steps, and empower care teams to do what they do best—deliver high-quality, person-centered care.

AI-Powered Care Management

Within the HealthEdge GuidingCare® platform, a comprehensive care management solution that integrates data analytics and workflow management tools to support evidence-based, person-centered care strategies, we introduced the AI Summarizer feature. This innovation streamlines how healthcare professionals process member information, enabling care teams to support more members at an increased scale while improving care quality and responsiveness.

The Information Processing Challenge

HealthEdge consistently hears from healthcare organizations that care managers face growing challenges with information overload from extensive member documentation. This challenge is especially pronounced for high-risk members, who may be contacted weekly or monthly, resulting in substantial volumes of detailed notes with free-text content that cover care plans, assessment responses, member outreach efforts, and more.

Through direct feedback from clinical teams, HealthEdge learned that care managers often read through extensive notes primarily to identify their next action items—what they need to do next for each member. This need for both background context and actionable next steps creates time-intensive workflows that reduce capacity for hands-on clinical work and individualized care planning.

Building Intelligence into Care Workflows

Recognizing the need for intelligent automation in care management workflows, our team developed an enterprise-grade solution using GenAI with stringent healthcare compliance standards. Our objective is to enable care managers to quickly assess and understand member needs while maintaining data privacy and clinical accuracy standards.

We embedded AI summarization functionality directly within existing GuidingCare workflows through a simple “Summarize” button in the Member Notes interface. The system analyzes all care management notes from the past 90 days using a carefully engineered prompt template approach. It then processes the input notes, extracting key member context and actionable items from the free-text content.

For example, when a care manager documents a phone conversation where a member mentions being unable to get medication refills due to financial issues, the summarizer feature can extract the specific action item: “reach out to community resources to find low-cost or subsidized medication options and share findings with member”—translating conversational content into specific workflow tasks.

The system produces two key outputs: a Member Summary highlighting key diagnoses, reasons for visit, and recent activities, plus an Actionable Follow-Ups section with a prioritized task list. This design responds directly to clinical team requirements for rapid identification of next steps for each member.

We implemented validation procedures, including testing and evaluation, along with integrated user feedback mechanisms such as thumbs-up/thumbs-down ratings and human oversight requirements. By collecting this feedback, we’ve laid the groundwork for continuous improvement, ensuring that user evaluations and suggestions directly enhance the precision and clinical applicability of AI summarization.

Security and responsibility remain at the core of everything we build. The solution maintains enterprise-grade security through secure APIs, HIPAA compliance, and role-based access controls confined to HealthEdge infrastructure. We also integrated responsible AI protocols, including explicit disclaimers about AI-generated content and human validation, so clinical judgment remains central to care decisions.

Operational Results and Performance

The AI Summarizer has already demonstrated a significant impact. It reduces care manager review time, decreasing the effort required to understand and act on member needs. This efficiency enables healthcare organizations to manage larger member populations while maintaining care quality standards through more informed and attentive clinical decisions.

Care managers now receive consolidated insights into member situations, with both background context and actionable next steps clearly identified. This supports faster response times and more targeted care approaches. Ultimately, our technology helps care managers redirect time from information analysis to direct clinical engagement—expanding their capacity for hands-on member care activities.

Delivering Immediate Impact

The AI Summarizer represents a practical solution to healthcare’s information overload challenge, delivering measurable time savings while maintaining clinical quality and compliance standards. For healthcare organizations struggling with care management efficiency, this technology offers immediate operational improvements with built-in safeguards for responsible AI deployment.

Looking ahead, we’re expanding AI capabilities across GuidingCare with enhanced interactive features, more intelligent summarization throughout workflows, and AI-powered agents designed to further streamline care management tasks. These upcoming enhancements will continue to reduce administrative burden while empowering care managers to focus on what matters most—delivering personalized, high-quality member care.

Shaping the Future of Care Management

The pressure on care managers will only continue to grow as health plans take on larger member populations and more complex care coordination. With our AI Summarizer in GuidingCare, we’ve shown how technology can transform documentation into actionable insights—helping health plans achieve operational efficiency without compromising care quality.

As we continue this work, we believe the future of care management will be defined by balance: smarter workflows powered by AI, and compassionate care guided by people.

Contact HealthEdge to learn how our AI Summarizer can streamline your care management operations and enhance member outcomes.