The HealthEdge GuidingCare Solution Suite
GuidingCare Population Health Management
The GuidingCare® Population Health Management module is a powerful, web-based care coordination solution designed for primary care providers, support services organizations, and key care partners. By integrating advanced gaps-in-care analytics, the platform empowers clinical teams to identify high-risk patients, uncover health improvement opportunities, and deliver proactive, data-driven care that transforms population health outcomes.
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GuidingCare Achieves AA Certification for HEDIS Measures Subset
GuidingCare Platform & Mobile Clinician App Earn CA Veracode Verified Status
GuidingCare Achieves NCQA Population Health Management Prevalidation
GuidingCare Platform Achieves HITRUST Certification
Features
Gaps-in-Care Analytics
Identify high-risk patients and uncover improvement opportunities with intuitive analytics that support both state and Federal quality measures like HEDIS and Star ratings, helping clinical teams focus on proactive and preventive care.
Care Transition Management
Gain real-time visibility into inpatient events with workflows designed to enable immediate, clinically appropriate interventions and seamless transitions across care settings.
Quality Measure Tracking
Evaluate performance against federal and state compliance metrics, including HEDIS and Star Ratings, and customize metrics for specific population needs to drive accountability and improvement.
Gaps in Care
Intuitive gaps-in-care analytics that allow clinical staff to identify high-risk patients and potential health improvement opportunities.
Population Stratification
Stratification rule sets identify health conditions and issues, provide risk scores and assign individuals to various workflows, along with suggestions for patient management activities.
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Discover how gaps-in-care analytics can help clinical staff identify high-risk patients and potential health improvement opportunities.
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healthEdge Care-Payer Integration
HealthRules Payer is even more powerful when combined with GuidingCare®. Our unique Care-Payer Data Exchange solution provides the API-based integration that enables the continuous management of member care and core administrative processes.
Care-Payer provides a range of vital capabilities, including:
- Standardized core data delivery from HealthRules Payer to GuidingCare
- Authorization entry workflow improvement, including single-case agreement and referral category enhancement
- Near-real-time authorization delivery from GuidingCare to HealthRules Payer
Most notably, Care-Payer includes Benefit Predictor integration. This unique feature enables GuidingCare users to quickly and easily answer complex benefit questions prospectively from members and providers.
This Benefit Predictor integration is incorporated into several key workflows, giving Utilization Management staff and care managers unparalleled access to near-real-time benefits information.
Care-Payer Data Exchange delivers significant benefits to your organization, including:
- Smooth implementation through HealthEdge expertise and standardized processes
- Synchronized data sets between HealthRules Payer and GuidingCare
- New levels of operational efficiency in authorization entry and medical management
- Improved payment integrity
- Certified data exchange
HealthEdge Care-Wellframe Integration
HealthEdge Care-Wellframe is a scalable, flexible integration that brings together Wellframe and GuidingCare, our full-spectrum care management platform, into one unified solution that offers health plans a comprehensive package with the right tools to transform their care management function.
The Care-Wellframe integration enables health plans to:
- Streamline Care Management Workflows: A fully integrated solution provides care managers with a comprehensive member view through a singular care management platform – no more swivel chair.
- Enhance Member Engagement: Meet members where they are on their own terms through omnichannel communication and a multi-modal digital front door.
- Scale Care Management Resources: Maximize care manager efficiency and support more members with dynamic decision support tools, alerting logic, and instant access to clinical and community SDOH resources.
With Care-Wellframe, health plans unlock the power to revolutionize care management operations and elevate member outcomes through a seamless, unified solution designed for impact and scalability.
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Enhance Pediatric Care with GuidingCare® Pediatric Population Health Management
Tailored to meet the unique needs of pediatric patient populations, the GuidingCare® Pediatric Population Health Management module empowers payers and providers to ensure effective and proactive care management for younger members.
This advanced solution supports developmental milestone assessments, accurate tracking of vaccination schedules, and compliance with Federal EPSDT requirements and state-specific quality measures.
With GuidingCare Pediatric Population Health, you can reduce administrative burdens, eliminate provider abrasion, and focus on driving better care outcomes for the next generation of members.
Explore the GuidingCare Pediatric Population Health Management solution and transform your approach to pediatric care.
Key Features:
- Simplified Compliance: A dedicated EPSDT dashboard streamlines access to member-specific data, past visits, and upcoming milestones, helping care teams stay ahead in meeting quality standards.
- Proactive Interventions: Automated workflows for assessments, screenings, and outreach support timely action to address care gaps and improve outcomes.
- Intuitive Insights: Easy-to-understand reports enhance data transparency at the member and population level, speeding state and federal quality reporting.
Explore the GuidingCare Solution Suite
GuidingCare®
GuidingCare offers a comprehensive suite of modules tailored to meet the evolving needs of healthcare payers and providers. Designed to operate seamlessly within your existing ecosystem, our solutions ensure interoperability, adaptability, and future-proofed capabilities for today's evolving care environments.
Learn MoreGuidingCare Care Management
Effectively operationalize an evidence-based, person-centered care strategy with workflows that align with NCQA standards, CMS guidelines, and personalized care requirements. Enhance operational efficiency while enabling care teams to identify gaps and take targeted actions.
LEARN MOREGuidingCare Utilization Management
Simplify and optimize the complete authorization lifecycle with advanced tools that integrate clinical guidelines, predictive modeling, and AI-driven workflows to boost productivity and reduce administrative bottlenecks.
LEARN MOREGuidingCare Authorization Portal
Streamline provider interactions with an intuitive tool for preauthorization, messaging, and appeals. Empower providers and staff with an interface designed for clarity and simplicity while ensuring alignment with compliance standards.
Learn MoreGuidingCare Appeals & Grievances
Streamline the appeals and grievances process to meet regulatory demands with automated workflows, task tracking, and correspondence. Configurable tools ensure compliance and timely resolutions for all grievance types.
Learn MoreGuidingCare Business Intelligence
Make smarter decisions with over 50 standard reports and an actionable analytics suite. Uncover trends, build ad hoc reports, and transform data into strategic insights.
Learn MoreGuidingCare Population Health Management
Leverage advanced gaps-in-care analytics to identify high-risk members, prioritize interventions, and optimize health outcomes. Empower care teams with SDOH and analytics to address risk factors and inequities for more effective care.
Learn MoreAdvanced Tools for Transformation
GuidingCare University
Empower your team with our self-service digital training platform offering on-demand, video-based learning to optimize user interaction with the GuidingCare Solution Suite.
LEARN MOREGuidingCare Rules Designer
Independently create, manage, and deploy business rules into your GuidingCare instances to automate workflows and decision-making.
GuidingCare Pediatric Population Health Management
Standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.
LEARN MOREGuidingSigns® Analytics
A clinical decision support system that transforms data into actionable insights for healthcare payers and providers.
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