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U.S. Healthcare Payer Care Management Workflow Applications

U.S. Healthcare Payer Care Management Workflow Applications Reviews and Ratings

What are U.S. Healthcare Payer Care Management Workflow Applications?

Gartner defines the U.S. healthcare payer care management workflow applications market as software products that provide technology support for a broad set of processes within the medical management department. These products are increasingly delivered as secure cloud-based platforms, but may also be deployed on-premises or in a hybrid model.

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Logo of EssetteSuite

EssetteSuite

By HMS

4.4
(8 Ratings)

EssetteSuite is a software designed to support care management processes by enabling organizations to coordinate and manage health care services across multiple settings. The software offers modules for care management, utilization management, and population health, allowing users to track patient interactions, document care plans, monitor outcomes, and facilitate collaborative care among providers. EssetteSuite incorporates reporting and analytics capabilities to support regulatory compliance and inform organizational decision making. The software is intended to help organizations address challenges related to efficiency, patient engagement, care coordination, and resource utilization within health management operations.

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Logo of GuidingCare Care Management 

GuidingCare Care Management 

By Altruista Health

4
(5 Ratings)

GuidingCare Care Management software is designed to support care coordination, case management, and population health management for healthcare organizations. The software facilitates workflows for member engagement, assessments, care planning, utilization management, and reporting. It integrates with electronic health records and other data sources to provide a unified view of member information. GuidingCare Care Management software aims to help organizations manage tasks related to member outreach, care team collaboration, and compliance with regulatory requirements. The software is intended to address the needs of health plans and provider organizations seeking to improve operational efficiency, care quality, and health outcomes for the populations they serve.

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Logo of HELIOS Care Management & Case Management

HELIOS Care Management & Case Management

By VirtualHealth

4.3
(3 Ratings)

HELIOS Care Management & Case Management is a software developed to support the needs of healthcare organizations by streamlining care management and case management workflows. The software offers features for care coordination, patient tracking, documentation, task management, and communication among multidisciplinary teams. It enables integration with electronic health records and other healthcare systems to facilitate the consolidation and sharing of patient information. The software is designed to enhance the management of population health, support care planning, monitor compliance, and help healthcare professionals identify gaps in care. It addresses the business challenge of optimizing resource allocation, reducing administrative burden, and improving outcomes through structured and automated case and care management processes.

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Logo of Acuity Advanced Care

Acuity Advanced Care

By TCS Healthcare Technologies

4
(1 Rating)

Acuity Advanced Care is a software designed to optimize patient care management for healthcare organizations. The software provides functionalities for monitoring patient health data, streamlining clinical workflows, and enabling efficient communication among medical teams. It supports data integration from multiple sources to offer comprehensive patient profiles, aiding in quicker and more informed decision-making. Acuity Advanced Care addresses the challenge of managing high-acuity patients by offering tools for early risk identification and resource allocation. The software’s analytics capabilities help organizations analyze trends and outcomes, while its interoperability features ensure smooth data exchange across existing healthcare systems.

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Logo of Cognizant Health TranZform

Cognizant Health TranZform

By Cognizant

5
(1 Rating)

Cognizant Health TranZform is a software designed to support healthcare organizations in managing administrative and clinical workflows. The software offers features such as patient engagement, care coordination, and population health management. It facilitates data integration from multiple sources, supports interoperability, and provides tools for analytics and reporting. Cognizant Health TranZform aims to address business challenges in healthcare operations by streamlining processes, enhancing communication among care teams, and improving the management of patient information. The software also focuses on compliance with industry standards and seeks to optimize resource utilization within healthcare organizations.

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Logo of Healthcare Administration

Healthcare Administration

By SS&C Technologies

3
(1 Rating)

Healthcare Administration is a software developed to support the management of administrative processes within healthcare organizations. The software streamlines tasks such as patient registration, appointment scheduling, billing, insurance claims processing, and medical record management. It is designed to help healthcare providers improve operational efficiency by automating routine administrative activities and enabling centralized data management. Healthcare Administration also supports regulatory compliance by maintaining secure records and facilitating accurate reporting. The software addresses the business problem of reducing administrative overhead and minimizing errors commonly associated with manual processing in healthcare environments.

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Logo of Jiva

Jiva

By ZeOmega

3
(1 Rating)

Jiva is a software designed to support care management and population health management for healthcare organizations. The software provides tools for managing workflows related to case, disease, and utilization management. It enables organizations to aggregate and analyze patient data from multiple sources, facilitating the identification of at-risk individuals and optimizing health outcomes. Jiva software offers features for automating clinical processes, coordinating care, managing compliance, and reporting metrics. It aligns care activities across different settings and stakeholders, aiming to streamline administrative functions and enhance the efficiency of care delivery. The software supports regulatory requirements and interoperability with other healthcare information systems.

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Logo of Aerial

Aerial

By Medecision

Aerial is a software that provides a platform for care management and population health management within healthcare organizations. The software enables users to collect, analyze, and use data to coordinate care and manage patient populations. It offers tools for workflow automation, communication among care teams, and integration with electronic health record systems. Aerial is designed to support clinical decision-making and operational efficiency by aggregating patient data, identifying care gaps, and tracking interventions. The software assists healthcare providers in addressing compliance requirements and improving resource utilization by facilitating the management of patient care plans and monitoring outcomes.

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Logo of CarePoint

CarePoint

By AxisPoint Health

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Logo of CareRadius

CareRadius

By EXL

CareRadius is a software designed to support care management and utilization management processes for healthcare organizations. The software offers tools for case management, disease management, utilization review, and population health management. It helps streamline workflows by automating tasks such as documentation, communication, and authorization requests. CareRadius enables the aggregation and analysis of patient data from different sources, assisting clinical and administrative staff with decision-making and compliance requirements. The software aims to improve coordination among healthcare teams, reduce administrative burden, and support regulatory standards by providing configurable workflows and reporting features to address business challenges in managing patient care and utilization.

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Logo of CareSpace

CareSpace

By Persivia

CareSpace is a software designed to support healthcare organizations in managing population health, care coordination, and value-based care initiatives. The software provides tools for tracking patient health data, risk stratification, and quality measurement. It enables care teams to collaborate by streamlining workflows and integrating information from various sources. CareSpace addresses the challenge of improving patient outcomes while controlling costs by offering analytics and reporting capabilities to monitor performance and identify gaps in care. The platform assists in regulatory compliance and facilitates billing and reimbursement processes under different payment models. CareSpace is used to enhance clinical decision-making and operational efficiency in healthcare settings.

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Logo of CaseTrakker

CaseTrakker

By IMA Technologies

CaseTrakker is a software designed to support organizations in managing care coordination processes. The software offers tools for documentation, workflow automation, case management, and reporting. Users can track case status, record interactions, and manage documents related to each case. CaseTrakker aims to help organizations address business needs such as improving efficiency in handling cases, ensuring regulatory compliance, facilitating communication among care teams, and maintaining accurate records for auditing and analysis purposes. The software’s functionalities are structured to streamline case management activities, reduce manual tasks, and provide oversight over care coordination outcomes.

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Logo of HealthRules CareManager

HealthRules CareManager

By HealthEdge

HealthRules CareManager is a software designed to support care management and coordination processes for health plans and other organizations in the healthcare industry. The software enables users to manage care plans, identify and address gaps in care, monitor patient progress, and analyze population health data. HealthRules CareManager provides tools for case management, disease management, and utilization management, helping organizations streamline workflows and improve communication among care teams. The software aims to address business challenges related to care coordination, regulatory compliance, and quality reporting, offering configurable workflows and integration with other healthcare systems to facilitate efficient care delivery and improve health outcomes.

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Logo of MedHOK Unified Payer Platform

MedHOK Unified Payer Platform

By Medhok

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Logo of mPulse Mobile

mPulse Mobile

By mPulse Mobile

mPulse Mobile software offers a communication platform designed to support healthcare organizations in engaging with their patients through automated messaging and conversational technology. The software supports SMS, IVR, email, and other channels to deliver educational content, appointment reminders, and satisfaction surveys. It features capabilities for automating workflows, personalizing interactions, and analyzing engagement data to improve program effectiveness. mPulse Mobile software addresses challenges such as patient nonadherence, missed appointments, and low health literacy by facilitating timely and targeted outreach. The software focuses on helping healthcare organizations streamline communication, enhance engagement, and optimize patient outcomes by leveraging data-driven insights.

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Logo of Pega Care Management

Pega Care Management

By Pegasystems

Pega Care Management is a software designed to support healthcare organizations in coordinating care activities, managing patient information, and automating workflows for care teams. The software provides capabilities for care planning, case management, and task tracking to streamline the collaboration between providers, payers, and patients. Through configurable rules and process automation, it enables users to address complex care scenarios and improves administrative efficiency by reducing manual processes. Pega Care Management offers data integration features to centralize member records, assist in eligibility determination, support pre-authorization processes, and provide analytics to help identify care gaps. The software is used to address challenges related to the management of patient care and information exchange within healthcare ecosystems.

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Logo of ​TruCare

​TruCare

By Casenet

TruCare is a care management software designed to support healthcare organizations in managing population health, utilization, and case management processes. The software provides functionalities such as member stratification, risk assessment, workflow automation, and clinical data integration. TruCare enables care teams to coordinate and track interventions, document patient information, and adhere to regulatory compliance requirements. By centralizing patient records and care plans, the software aims to streamline collaboration among providers, improve care outcomes through actionable clinical insights, and support organizations in achieving operational efficiency. TruCare addresses the challenge of managing complex patient populations and provides tools for proactive care management and reporting.

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Features of U.S. Healthcare Payer Care Management Workflow Applications

Updated December 2025

Mandatory Features:

  • Role-based access controls

  • Care plan creation, documentation, tracking and management capabilities

  • Rule or analytics-driven member identification and stratification

  • Tools for secure messaging, communication and collaboration

  • Dashboards and reporting tools for monitoring outcomes, program performance, regulatory compliance and population health metrics

  • Task assignment, reminders and workflow routing

  • Ability to integrate with core administrative processing systems (CAPS) and other payer/provider systems for data sharing

  • Comprehensive and compliant documentation capabilities for all care management activities, including assessments, outreach and follow-up

Gartner Research

Market Guide for U.S. Healthcare Payer Care Management Workflow Applications

Popular Product Comparisons

GuidingCare Care Management  vs HELIOS Care Management & Case ManagementGuidingCare Care Management  vs JivaCognizant Health TranZform vs GuidingCare Care Management Cognizant Health TranZform vs HELIOS Care Management & Case ManagementAcuity Advanced Care vs Cognizant Health TranZformCognizant Health TranZform vs EssetteSuiteEssetteSuite vs HELIOS Care Management & Case ManagementEssetteSuite vs GuidingCare Care Management 

Gartner Peer Insights content consists of the opinions of individual end users based on their own experiences, and should not be construed as statements of fact, nor do they represent the views of Gartner or its affiliates. Gartner does not endorse any vendor, product or service depicted in this content nor makes any warranties, expressed or implied, with respect to this content, about its accuracy or completeness, including any warranties of merchantability or fitness for a particular purpose.

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