Case Study: Empowering Innovative Healthcare with Integrated HealthEdge® Solution

Effective care management is pivotal to member health, and it thrives when empowered by next-generation solutions. The GuidingCare solution suite stands at the forefront, offering health plans mission-critical workflow solutions that deliver superior outcomes within a value-based, member- and patient-centric ecosystem.

Building Trusted Partnerships

GuidingCare operates across 50+ unique organizations, including 50% of ACAP membership, streamlining performance with over 5 billion transactions processed annually through 30+ real-time APIs and accessed by 50k+ users.

Enabling Complex Care Models

GuidingCare manages over 20 million contracted lives and supports 50% of all MLTSS members and 20% of Medicaid members nationally.

Leading with Experience

With over 100+ years of cumulative experience and 50+ years guiding customers through implementations, HealthEdge’s GuidingCare is part of a comprehensive suite delivering digital transformation in healthcare. This complete care management solution enables digital payers to enhance business transparency, advance customer service, improve quality, reduce transaction costs, and optimize member-centricity.

The GuidingCare Solution Suite

GuidingCare’s integrated solution suite empowers stakeholders to collaborate more effectively and enhance both care and financial outcomes. It includes:

• Care Management - Tools to operationalize evidence-based, person-centered care management strategies.
• Utilization Management - Supports the complete authorization lifecycle with clinical guidelines and workflow management.
• Appeals & Grievances - Streamlines the entire appeals process to meet regulatory demands.
• Authorization Portal - Simplifies preauthorization, appeals, and messaging processes.
• Business Intelligence - Provides real-time insights for advancing care management.
• Population Health Management - Coordinates directly with providers to manage high-risk populations and close care gaps.

What Makes GuidingCare Unique?

GuidingCare is a highly composable system enabling competitiveness in an evolving market. It offers deep clinical expertise, reimagined implementation, market-leading innovation, resiliency to change, ease of integration, actionable insights, operational efficiency, regulatory support, and security & compliance.

Success Stories

• Elderplan - Enhanced clinical and operational processes, improved staff and member experiences, and met regulatory demands.
• Priority Health - Automated preauthorization processes, reduced administrative burdens, and improved response times.
• Commonwealth Care Alliance (CCA) - Created customizable workflows based on social determinants of health.

GuidingCare is committed to driving digital transformation in healthcare, ensuring a connected and efficient ecosystem that optimizes clinical and business outcomes. Join the HealthEdge ecosystem to lead the way in creating a modern, interconnected healthcare system. Learn more and see how this complete care management solution for health plans can benefit your organization today.