Technology and Data Management

Our full spectrum of technology- enabled solutions are designed to maximize health outcomes and contain healthcare costs.

About

Carewise Health gives our customers access to proprietary data services and technologies in support of our Care Management and Payment Integrity solutions.

Our Platform

Our Technology platform hosts best-in-class processing, data mining and reporting capabilities.

Data Intake and Enrichment

Data is powerful. But to maximize its use, it must be well prepared. Unclean data can lead to inaccurate conclusions and misguided solutions.

Data Warehousing

In addition to our data intake and enrichment services, we provide data warehousing to support timely, accurate analysis and reporting.

Business Process Management

Carewise Health offers a BPM solution that takes advantage of advanced proprietary data assembly and analytic models to assist customers in re-engineering various operational processes primarily related to the delivery of their clinical programs and services.

Security and Compliance

The data security landscape is constantly changing, with new threats and risks emerging continually. Our Office of Compliance sets and upholds the highest standards for our entire enterprise and all business partners.

Experience Carewise Health

Our focus on data and technology deployed through our experienced nurse clinicians and coaches allows our customers to positively impact the health and reduce benefits costs related to their beneficiaries and employees.

Our proprietary behavioral analytics are used to gain insight into member behavior patterns that can adversely impact benefit expense. We detect the pattern of activity, and then contact the member for engagement in one of our care management programs. Our nurse specialists can then focus with the members on selected care episodes. Our goal is to intervene with tools and feedback that is likely to impact a member’s behavior and future health care activity.

Rather than looking solely at claims and clinical data, we develop a deep understanding of behavior, interactions and patterns that are the basis of effective, customized solutions. Carewise Health is transforming the field of healthcare data by merging care management that combines in-depth clinical, behavioral, financial and provider analytics to provide a suite of services designed to make the most of data resources. Our products locate opportunities for improved care coordination that result in cost savings and elimination of unnecessary or ineffective treatment.

Carewise Health has an exclusive contract with Certilytics, Inc. to deploy proprietary data analytic models to support Clinical Care Management and Payment Integrity product offerings.

Clinical Care Management
Analytics are used to identify and predict member behavior and potential impact on clinical outcomes. The models are designed to incorporate and use both clinical and non-clinical data sources to enhance the predictive features. This allows nurses engagers to focus on those members at timely and significant points of care episodes to intervene, and to intervene with tools and input most likely to impact a member’s behavior and health care activity.

Payment Integrity
Analytics are used to more precisely define those cases that should require additional clinical and payment audits. This predictive feature is designed to minimize any impact on providers and their teams, as audits and payment reconciliations are completed.