U.S. Healthcare Payer Care Management Workflow Applications Reviews and Ratings
What are U.S. Healthcare Payer Care Management Workflow Applications?
U.S. healthcare payer care management workflow applications are enterprise software products that provide technology support for a broad set of processes within the medical management department. The primary payer care management workflow applications user is the payer-employed care manager (under titles such as nurse, care coordinator, health coach or health advocate). This person does the work of utilization management (UM), case management (CM), disease management (DM) or wellness program support.
The work includes comparing requested services against standards of medical necessity; interacting with providers and their administrative staff; completing assessments with members during telephone engagements; establishing and documenting progress on care plans; and motivating member behavior change. The role of the care manager, however, is diversifying in today’s market. Care managers work in support of many different business and operating models, deploying widely differing expertise across different communication channels
Product Listings
Filter by
Gainwell Technologies is focused on providing digital and cloud-enabled solutions which are critical for the administration and operations of programs related to health and human services. It has a proven track record of over five decades. The main business problem Gainwell Technologies solves involves providing scalable and flexible solutions for complex challenges organizations face. The company's prowess lies in delivering reliable and innovative solutions which facilitate transformative results.
Altruista Health is a technology solutions company that contributes to managing population health. Incorporated in 2007, the company offers technologies intended to facilitate collaborative, data-informed, and patient-oriented health management. Altruista Health developed GuidingCare, an online population health management system that helps health plans to optimally utilize their data and enhance care quality for high-risk individuals. GuidingCare integrates data from numerous systems, such as medical and pharmacy claims, EMR/EHR, eligibility, HIEs etc., to deliver role-optimized workflow management tools that cater to care coordination, care transitions management, quality improvement, and utilization management among others.
VirtualHealth is a company that offers HELIOS, a comprehensive care management platform designed to facilitate the full spectrum of care. This tool is designed to serve health plans by managing large groups of members and optimizing person-centered care. It combines intelligent case, disease, and utilization management workflows with extensive collaboration, patient engagement, real-time telehealth, adjustable analytics, and reporting. The system also accommodates standard and custom data integrations. Holding HITRUST CSF certification and NCQA preconditioned for Population Health, HELIOS enables healthcare organizations to improve their outcomes and efficiency, boost transparency and reduce costs.
TCS, part of the Tata group, focuses on shaping the future through innovation, technology and the utilization of collective knowledge. It is a multinational organization based in India, with consultants placed in various countries around the world, with notable skills and expertise. They work diligently to provide technology solutions that resolve critical business challenges. TCS is also noted for proactive stances on critical global issues, resulting in recognition in various sustainability indices. It operates within business principles aligned towards achieving sustainable growth.
Cognizant is focused on engineering modern businesses. The main problem it resolves is helping clients with modernization of their technology, reimagining their processes, and transforming their experiences to adapt to the rapidly changing world. Thus, the main goal of the company is to facilitate improvement in everyday life.
Cognizant helps companies modernize technology, reimagine processes and transform experiences so they stay ahead in a fast-changing world.
SS&C is a global entity specializing in mission-critical, cloud-based software and solutions aimed at the financial and healthcare sectors. With operations scaling over 40 countries, SS&C works mainly with financial services and healthcare organizations. Its services encompass a spectrum of expertise and innovative approaches to cater to the specific needs of these sectors. It is an established entity with a substantial employee base.
ZeOmega is a company that provides technology solutions to assist health plans and risk-bearing organizations in managing population health. It offers the Jiva Healthcare Enterprise Management Platform that streamlines workflow and yields proficient outcomes due to integrated features, extensive clinical content, and a robust rules engine. Leveraging its domain knowledge and understanding of population health complexities, ZeOmega tailors its delivery and deployment models to match the client's needs. ZeOmega, which started operations in 2001, is privately owned and has its headquarters in Plano, Texas.
Medecision is a digital care management firm, providing solutions and services employed by prominent health plans and care delivery organizations. In excess of 42 million people across the nation benefit from these services. A notable product from Medecision is Aerial, a HITRUST CSF-certified, SaaS solution. Aerial connects the healthcare network to impactful data and insights. It contributes to effective consumer engagement and generates efficiencies that cause a reduction in costs, and supports proficient care, case and utilization management.
EXL is a data analytics and digital operations and solutions company. It partners with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to generate insights from data and deliver outcomes for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others.
Recognizing that businesses have unique needs, cultures, goals, and existing technological set-ups, EXL emphasizes collaboration and flexibility in its approach. EXL also aids in the scaling of AI, Generative AI and digital usage, redesigning operating models for added efficiency, and facilitating quicker, more effective decision-making. EXL looks into the entire value chain of a business to integrate impactful strategies and deliver successful outcomes that align with the goals of the business.
Persivia, previously known as DiagnosisOne, was established in 2005. The company is rooted in Massachusetts and was created by a group of physicians and healthcare IT professionals. The company primarily offers a unique integrated platform called CareSpace, that utilizes artificial intelligence to gather and analyze data from various databases and create a precise longitudinal record for every patient. This AI-driven platform has a feature called CareTrak that enables bi-directional connectivity with EHRs. Another unique feature, SmartPHIN, supports state public health departments in managing large-scale epidemics like COVID-19. Through this platform, Persivia aims to improve the management of value-based care models and provide real-time, personalized patient care insights. The firm serves 200+ hospitals and has a user base of more than 8000, impacting over 20 million patients nationally.
The company's primary focus is engineering services. These services include diagnosis, repair, maintenance, upgrading, and refurbishing electric panels for electric generation control and automatic transfer switches (ATS) control. The main problem the company solves is ensuring optimal operation of electric panels, thereby preventing electrical failures or inefficiencies that could hinder electric generation and transfer processes.
HealthEdge has an objective to foster a digital revolution in the healthcare sector. The company uses connecting business models between health plans, care providers, and patients with inclusive digital technology solutions. These efforts are aimed at supporting new operational models, reducing management costs and enhancing health outcomes. HealthEdge has an expanding range of products, like HealthRules Payer, Source, GuidingCare, and Wellframe, all aimed at transforming healthcare. Empowered by a global team of over 2,000 professionals, the focus is on introducing an innovative environment where the primary focus of healthcare is people.
mPulse Mobile is a company that specializes in Conversational AI solutions specifically designed to enhance health outcomes and amplify business efficiencies. It achieves this by involving individuals in custom-made and purposeful conversations. Incorporating industry expertise, behavioural science, and analytics, mPulse Mobile assists health organizations in activating their consumers towards cultivating healthy behaviours. Boasting more than a decade of service, the company facilitates over a billion dialogues year-on-year, thereby influencing healthy behavioural change.
Pega provides a low-code platform that empowers the world’s leading enterprises to Build for Change. Clients use Pega's AI-powered decisioning and workflow automation to solve their most pressing business challenges – from personalizing engagement to automating service to streamlining operations. Since 1983, Pega has built their scalable and flexible architecture to help enterprises meet today’s customer demands while continuously transforming for tomorrow.
Zyter|TruCare is located in Rockville, Maryland and maintains international offices in a variety of locations including Boston, Dallas, Bangalore, and Prague. The firm combines the capabilities of Casenet TruCare and Zyter Health to create healthcare technology platforms. These platforms support payers, providers and public health institutions with the management of value-based care. They unite multiple facets, for example, Care Management, Telehealth, Remote Patient Monitoring in a single platform. In addition, they include intelligent services to extend the adaptability of home-based care by consumers and caregivers. Zyter|TruCare's solutions integrate non-acute and digital care solutions into a coordinated offering. This helps drive positive outcomes for populations with complicated healthcare needs under evolving managed care models. The company's operations comply with healthcare industry regulations.