Member engagement simplified
CareMetrix: proactively elevating health plan quality ratings
Quality metrics elevated.
Reimbursement rates, bonuses, and reputational risk are directly tied to healthcare quality ratings like HEDIS® and CMS Star ratings -- and members are paying attention.
CareMetrix empowers health plans to achieve exceptional performance on these critical measures by proactively automating the identification and closure of care gaps before annual scores are finalized.
Member engagement simplified.
Our platform provides real-time quality score tracking, highlights low scores, and automates targeted member and provider outreach to drive measurable improvements.
By bridging gaps in care and addressing social determinants of health (SDoH) insecurities, CareMetrix helps payers achieve better adherence to contractual quality measures while improving member health outcomes.
With CareMetrix, health plans don’t just track quality -- they actively enhance it, ensuring improved ratings, higher reimbursement, and stronger member satisfaction.
Automated end-to-end cloud platform to analyze, trend, and close care gaps.
Clinical
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Automated member engagement workflows and strategies maximize survey completion rates and effectiveness of interventions like preventative wellness screenings
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Produces HEDIS, FHIR, and PDF data files ready for reporting and compliance
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Manages near real-time digital quality measurement workflows
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Provides audit preparation and management services, including user-generated conformance and validation reports
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Integrates with best-in-class engagement incentives administration service vendors
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Enriches data and verifies race, ethnicity, and language data for public reporting use cases
Technical
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Designed to meet the HITRUST standards of healthcare application security to ensure compliance with client and industry standards
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Hosted on secured cloud services with dedicated client environments to minimize data exposure
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Accommodates proprietary data files
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Partitioned and secure API implementation that resides on your existing AWS or Azure cloud architecture.
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Adaptative to inbound file input formats while providing vendor ready output file formats for low-friction ETL
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Eliminates value mapping and validation procedures with readily available LOINC codes and survey score values
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Provides multi-layered data management and provenance management
Key features and benefits
The CareMetrix STEP platform provides a secure technical ecosystem for identifying and seamlessly managing gaps in care and member engagement.
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Simplified plan workflows - seamless integration unifies the user experience across plan departments
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Intelligent automation - member care engagement tracking and automated course corrections increase engagement rates in near real-time
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Cost savings - platform operates in the cloud, minimizing technology investments
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Standardized output data - meeting HEDIS®, FHIR®, and EHR integration use cases, so additional tools are not needed to mediate interoperability
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Ongoing metrics updates - STEP is constantly updated with state and federal quality requirements
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Configurable - system has an easy-to-use interface to add additional custom measures
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Targeted interventions - automated member engagement workflows and strategies, targeted towards demographic variables, maximizing survey completion rates and effectiveness of interventions
