Prioritize the right members at the right time for targeted interventions
Advanced risk stratification linking individual and environmental factors to actionable interventions. Key impacts: Increased screening rates, reduced health inequities, and improved enrollment in appropriate SDOH programs.
Predict and prevent readmissions for hospitalized and recently discharged patients. Key impacts: Reduced 30-day readmissions, improved care coordination, and enhanced follow-up.
Identify hospitalized members who could be discharged home with services instead of to SNF/IRF. Key impacts: Reduced facility post-acute utilization, fewer SNF days, improved workflow efficiency, and shorter hospital stays.
Provide timely palliative care when quality of life becomes a priority alongside medical intervention. Key impacts: Enhanced quality of life, reduced costs from late-stage interventions, fewer unplanned readmissions, and ultimately timely hospice enrollment.
Recognize when the time is optimal for a member to transition to hospice care. Key impacts: Improved end-of-life decisions, increased clinician confidence, optimized hospice referrals, reduced unnecessary medical utilization, better quality of life for patients and families.
Target patients for shorter SNF stays to facilitate sooner discharge home with robust services. Key impacts: Shorter SNF stays, improved patient satisfaction, and optimized care coordination.
Identify members for the CMS SNF three-day waiver to avoid unnecessary hospital stays. Key impacts: Increased timely waiver use, fewer hospitalizations, improved member satisfaction, and better use of high-quality SNFs.
Our secure, cloud-based solution generates insights in real time, helping care management teams quickly identify which patients to focus on.
Highlights patients who might benefit from further assessment, ensuring resources are used efficiently.
Automatically generates clinical justifications, highlighting control of baseline chronic illness and evidence of recent decline.
A consistent interface lets users navigate every module effortlessly — no extra training needed.
Presents longitudinal history in one place, allowing users to easily determine how to allocate their time.
Presents longitudinal history in one place, allowing users to easily determine how to allocate their time.
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