Skip to main content
logo Contact us

Data Sheet: Achieve Superior Health Outcomes and Operational Efficiency with AI-Powered Care Solutions

Discover how HealthEdge Care Solutions leverages advanced AI to streamline workflows, enhance care management, and deliver measurable outcomes for health plans and their members.

Download PDF

AI-Powered Care Solutions: Enhancing Health Outcomes and Operational Efficiency

Health plans are tasked with the critical dual objective of improving member health outcomes while managing operational costs. Achieving this balance requires intelligent, AI-driven tools that empower care teams. HealthEdge Care Solutions provides an AI-Powered Decision Intelligence Ecosystem by integrating advanced artificial intelligence into the core workflows of GuidingCare® and Wellframe™. This integration enables care teams to operate with greater precision, streamline administrative tasks, and make data-informed decisions in real time.

By focusing on both care teams and members, HealthEdge transforms care management and member engagement into significant value drivers. This approach helps health plans reduce operational costs and substantially improve the overall member experience. According to the HealthEdge Annual Payer Survey Report, 34% of health plan leaders are adopting AI, machine learning, and advanced analytics as top strategies to combat rising costs.

GuidingCare®: An AI-Enhanced Care Management Platform

The GuidingCare® care management platform empowers clinicians to make faster, more informed decisions by automating manual tasks and surfacing critical insights through AI. This creates a more efficient care management process, ensuring members receive timely, personalized, and effective care.

AI-Enabled Capabilities in GuidingCare®

GuidingCare leverages AI to deliver tangible outcomes that improve care coordination and delivery.

  • Automated Clinical Summaries: This feature distills complex care management and utilization data into concise summaries. It reduces the cognitive load on clinicians, allowing them to quickly understand a member's history for faster, more confident decision-making. Learn more about how HealthEdge is leveraging AI to summarize GuidingCare notes.

  • Intelligent Care Guidance: The system provides AI-powered recommendations for next actions, tailored to each member's needs. This helps care teams prioritize interventions, ensuring members are on the optimal care path to reduce avoidable hospitalizations and associated costs.

  • Intelligent Document Processing: By automating data extraction from faxes and other documents, this capability eliminates manual workflows and reduces response times. This accelerates authorizations and frees staff for higher-value activities. Discover how to automate manual workflows with AI-enabled OCR.

  • Ambient Intelligence: In partnership with Suki, HealthEdge automates post-encounter note creation and assessment completion. This saves nurses valuable time, enabling more personalized member care and allowing organizations to manage more cases without increasing staffing costs. See the data sheet on Ambient Clinical Intelligence for Next-Gen Care Management.

Wellframe™: AI-Driven Digital Care Management and Member Engagement

The Wellframe™ platform utilizes AI to help care managers build stronger, more effective member relationships at scale. By combining real-time insights with intelligent automation, Wellframe enables care teams to deliver proactive, personalized support that helps individuals navigate their health journey, fostering greater trust and satisfaction.

AI-Driven Outcomes in Wellframe™

Wellframe's AI capabilities are designed to help health plans scale member engagement effectively.

  • Member Summaries: Synthesizes dynamic member data from various sources into concise, actionable insights. This optimizes care team workflows, enabling more efficient and impactful member support. The HealthEdge AI Summarizer empowers teams to deliver personalized care at scale.

  • AI-Powered Staff Assistant: This feature highlights the next best action and recommends specific engagement tactics for each member. It allows for personalized, timely support that can prevent escalations and improve health outcomes.

  • Automated Documentation: Creates intelligent, structured records of staff actions and member milestones. This simplifies administrative tasks, improves traceability, and ensures care delivery is captured accurately.

The HealthEdge Approach to Responsible AI Development

HealthEdge is committed to a disciplined, collaborative process that ensures accuracy, fairness, and accountability in all AI capabilities. Our AI is designed to augment, not replace, the human element of healthcare. Every model is guided by clinical input, rigorously tested for safety and equity, and built to support the care team.

This commitment is structured around the HealthEdge AI Framework.

Principle

Description

AI Principles

We align with established healthcare AI frameworks, including the Healthcare AI Commitments and guidelines from the Coalition for Health AI (CHAI™), to ensure safety and equity.

Responsible AI

Our enterprise AI risk governance incorporates the National Institute of Standards and Technology (NIST) AI Risk Management Framework to address security, ethics, privacy, and fairness.

Collaboration & Partnership

We partner closely with customers and industry stakeholders to develop AI-enabled solutions that address the evolving needs of the market.

Operational Value

Our focus is on developing AI features that generate meaningful outcomes, empowering health plans to adapt to dynamic market changes and demands.

 

Transform Your Health Plan with HealthEdge

HealthEdge is dedicated to developing powerful, AI-enabled solutions that align with the evolving needs of the market and our customers. With a responsible approach to AI, HealthEdge ensures the seamless integration of new capabilities that can transform your health plan and the care members receive.

To learn more about our enterprise strategy, explore how HealthEdge AI is transforming operations and care delivery or visit healthedge.com to begin your transformation.