Application Suite

Carewise Health operates an extensive suite of proprietary applications in support of the Clinical Care Management and Payment Integrity solution offerings. Our customers are not required to purchase, install or operate any software, but have the advantage of Carewise’s secure, state-of-the-art data and IT infrastructure. Our nurse clinicians and auditors use the applications to deliver the care management services to members and effectuate the payment integrity audits.

The current Carewise Health platform uses industry standard Microsoft, SQL server, Oracle, IBM and numerous commercially-available tools and products to operate it’s infrastructure. The platform provides full functionality in support of service delivery that processes inputs, workflows and outputs relevant to each application area.

Key Features:

  • Platform hub uses multi-client architecture
  • Hub integrates multiple data domains, organizes & delivers a 360° view of the participant
  • Risk profiling system generates a comprehensive risk profile for members that identifies clinical, financial and lifestyle risks
  • The profile then drives the workflows and interventions that are managed across multiple channels
  • Rule based & Configuration driven platform for managing complex client/employer programs
  • Member Portal provides a single point of access to a member for health related services
  • Integration framework with existing client solutions
  • Mix of proprietary and third party technologies

Big Data

In addition to the stand-alone Carewise IT hub and infrastructure, Carewise Health has signed an exclusive agreement with Certilytics, Inc. to use their “big data” Hadoop IT platform to develop enhanced applications that seamlessly integrate Certilytics proprietary analytics with Carewise Health applications. Commercial versions of these enhanced applications will be available for customer implementations in 2015 in support of customer’s health benefit plans effective January 1, 2016.