Population Health Management

Unified Data. Coordinated Teams. Exceptional Outcomes.

Transforming Population Health Management Through Collaborative Efforts

Managing population health requires seamless collaboration between Care Management, Utilization Management, Risk Adjustment, and Member Engagement teams. Yet, fragmented data and siloed workflows create barriers that hinder the effectiveness of these interconnected efforts, resulting in missed opportunities to improve health outcomes and control costs.

The Challenges in Population Health Management

Limited Workflow Integration

Payer processes focused on optimizing the care their members receive are not integrated across the care continuum due to lack of shared data and visibility across workflows.

Inconsistent Member Data

Fragmented and non-standardized data makes it challenging to manage risk, track interventions and measure outcomes holistically across the care journey.

Inefficient Risk Stratification

Without accurate risk stratification across teams, high-risk members can go unnoticed, while resources are potentially misallocated to low-value engagements.

Limited Member Engagement Strategies

Engagement efforts often rely on outdated or incomplete insights, failing to address members’ unique needs and preferences in a timely and meaningful way.

How We Solve It

Enable Collaboration with Unified Data

Single Source of Truth

We leverage our proprietary EMPI to ensure that all data available across care management, claims, risk adjustment, engagement, EDW and external systems is matched to the right member and provider record. This creates a shared, universal longitudinal member record accessible by all teams.

Real-Time Insights Across Teams

Using a Common Data Model built on USCDI resources in the FHIR standard, we enable Care Management, Utilization Management, Risk Adjustment, and Member Engagement teams to work in sync. Everyone has the same up-to-date, actionable data to coordinate care and interventions.

Foster Member-Centric Engagement

Targeted, Timely Interventions

Through bi-directional data exchange, care teams can proactively reach both members and providers with tailored programs that address chronic conditions, preventive care needs, or address open care gaps.

Enhanced Provider Collaboration

Payers can play a more proactive role in identifying and delivering the care their members need, when they need it with analytics on real-time clinical and claims data paired with electronic prior authorization.

Learn more about improving outcomes through data-driven engagement

Why It Matters

Addressing these challenges with unified data and collaborative workflows leads to

Enhanced Member Satisfaction

Personalized and proactive care fosters loyalty.

Effective Risk Stratification

High-risk members receive timely, targeted care.

Lower Costs

Optimized utilization management reduces unnecessary expenses.

Care Gap Closure

Proactive engagement with members and providers to prospectively close care gaps.

Discover how we address other critical challenges for Health Plans

Explore More Problems We Solve

Utilization Management

Effectively balancing costs and care quality.

Risk Adjustment Precision

Ensuring accurate reimbursements for Payer and Provider.

Quality Improvement

Driving Star Ratings and HEDIS performance.

Take the Next Step Toward Population Health Excellence

Empower your teams with clean data, connected workflows, and actionable insights.

Contact Us Today

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