Data Sheet: GuidingCare Menu of Services

GuidingCare Menu of Services: Expert Support to Accelerate Success

GuidingCare® delivers a powerful suite of integrated, innovative solutions that enable health plans to improve population health, manage complex cases, and streamline care management processes. To help clients maximize their investment, our Global Professional Services (GPS) team provides expert services grounded in deep product expertise, industry best practices, and a proven methodology.

The GPS team helps clients implement and optimize GuidingCare solutions, ensuring they achieve their strategic goals. Our services range from initial implementation and configuration to ongoing support, education, and strategic consulting. This menu of expert services covers the platform’s core functionality to help you enhance your GuidingCare experience.

Core Service Areas

• GuidingCare Implementation: Foundational setup and deployment of the GuidingCare platform.
• GuidingCare Customization: Tailoring the platform to meet unique business rules and operational needs.
• GuidingCare Optimization: Ongoing enhancements to improve performance, efficiency, and outcomes.

Automate Complex Care Management Workflows

While GuidingCare has powerful workflow capabilities, automating complex care management processes requires detailed business rules, integration points, and precise configuration. As a health plan's business evolves, customizing and managing these workflows can become a significant challenge. The GPS team provides end-to-end support to help customers design, automate, and scale these critical workflows with precision.

Our End-to-End Workflow Support

• Business requirements and template analysis: We start by understanding your specific operational needs.
• Workflow design: We architect workflows that align with your strategic objectives.
• Workflow configuration: Our experts configure the platform to execute your designed processes.
• Testing and validation: We rigorously test all workflows to ensure accuracy and reliability.
• Ongoing support and optimization: We provide continuous support to refine and enhance workflow performance.

Customer Impact: Driving Efficiency in Authorizations

A health plan struggling with inefficient authorizations partnered with GPS to develop custom business rules. These rules were designed to automatically approve frequently approved procedures, resulting in a 50% improvement in their auto-authorization rate and enabling 20,000 automated approvals annually.

Create, Automate, and Scale Member Correspondence

Health plan communication strategies are shaped by unique branding, regulatory nuances, and diverse member populations. GuidingCare includes powerful correspondence capabilities, but health plans often require expert assistance to customize and manage this functionality. GPS provides comprehensive support to help customers design, automate, and scale personalized member communications.

What We Deliver for Correspondence

• Business requirements and template analysis
• Development of standardized, automated letter templates
• Configuration of complex correspondence rules
• Integration with mail and fax vendors
• Testing and validation of templates and workflows
• Ongoing support and optimization

Customer Impact: Streamlining Letter Templates

One health plan faced scalability and compliance challenges with over 1,200 letter templates. GPS helped consolidate them into just 250 templates—an 80% reduction. This enabled easier maintenance, more accurate reporting, and clearer member communication.

Seamlessly Exchange Data Across Platforms

To achieve a holistic view of member health, health plans must integrate data from various sources into GuidingCare. This process can be complex due to different data formats, protocols, and security requirements. The GPS team offers end-to-end support to help customers design, implement, and manage these critical data integrations.

Our Data Integration Services

• Data requirements and schema analysis
• Source system integration
• Data mapping and transformation
• Data validation and quality assurance
• Ongoing support and optimization

Customer Impact: Integrating Social Determinants of Health (SDOH) Data

A health plan needed to better incorporate unstructured SDOH data from community-based organizations. GPS built interfaces to extract, standardize, and map this data to relevant fields within GuidingCare. As a result, care managers gained a centralized, up-to-date view of key SDOH factors like housing status and food insecurity, enabling more informed care planning.

Generate Actionable Insights with Custom Reporting

Success metrics differ for every health plan. While GuidingCare offers a set of pre-built reports, many organizations require customized views and metrics aligned with their specific programs and goals. The GPS team collaborates with customers to build tailored reporting solutions that deliver the right insights at the right time.

What We Deliver for Reporting

• Requirements gathering and schema documentation
• Setup of a replicated reporting database
• Report design consultation and database navigation
• Testing and validation of reporting outputs
• Ongoing maintenance and enhancement

Customer Impact: Enhancing Population Health Monitoring

A health plan sought to improve its monitoring of population health trends. GPS helped create tailored reports that identified care gaps, chronic condition trends, and social risk factors. This enabled more targeted care planning, smarter resource allocation, and improved member outcomes.

Enhance Your GuidingCare Experience

Ready to unlock the full potential of GuidingCare and achieve your strategic goals? Talk to your Global Professional Services representative today to learn more about how our expert services can help.

For more information on our full suite of solutions, visit HealthEdge.com.