The Caradigm Intelligence Platform and Caradigm Care Management products focus on high-risk patients and on the preventive and chronic care needs of all patients. The technologies identify, assess and stratify patient cohorts so healthcare organizations can supplement care teams, manage patient populations, drive improved outcomes and decrease overall costs. The Platform and Management products are centered on four capabilities: data control; healthcare analytics; care coordination; and patient engagement.

For data control, the Caradigm population health technologies pull together patient data from multiple sources, transform that data into a consistent format, and store the data in a repository for easy access. The Caradigm Intelligence Platform offers prebuilt interfaces for a wide variety of systems, provides data normalization and terminology mapping, and combines both claims and clinical data.

Caradigm’s healthcare analytics technology identifies and measures outcomes and costs. To support complex population health management, the analytics deliver retrospective review, ongoing surveillance and predictive modeling. Caradigm offers a number of analytics systems designed to identify insights within the complexity of a healthcare organization’s business – including reporting on retrospective activity, monitoring current activity, predicting future activity and enabling root-cause analysis.

In the realm of care coordination and management, the vendor’s products are designed to help providers optimize care management for large patient populations across all risk segments. Caradigm Care Management enables a multidisciplinary care team to provide consistent care for high-risk and rising-risk patient populations. Team members gain a longitudinal view of a patient to enable timely and appropriate interventions and reduce unnecessary utilization.

Enli Health Intelligence's technology offers a population health management system designed to support care teams by integrating healthcare data and evidence-based guidelines into workflows. Enli risk stratification systems are designed to help provider organizations pursue payment incentives and value-based programs by identifying non-clinical and clinical determinants of risk, prioritizing risk groups and aligning cohorts with best practices-based care plans, all to drive early interventions with patients.

The software company’s value-based systems assist provider organizations with coordinating care for high-risk patients. These systems are designed to standardize best practices, improve administrative and clinical efficiency, and increase practice revenue by applying care management protocols to defined populations, informing care teams of progress toward plan objectives, and optimizing program resources.

Forward Health Group’s PopulationManager is designed to use the existing technology at a healthcare organization and data from any source – EHR, claims, labs and others – to quickly identify gaps in care to help providers create healthier patient populations and enable a successful transition to value-based care.

Designed for hospitals, group practices and health systems, PopulationManager aims to deliver complete, accurate and timely data directly to physicians so the caregivers can make better-informed decisions. The technology tracks clinical performance at the health system, clinic or physician level, and includes financial impact information. The technology further enables a provider organization to demonstrate results to payers, patients and the community.

Forward Health Group’s PopulationManager aims to enable improved outcomes in the management of chronic conditions and preventive care; achieve stability and income assurance in the treatment of high-risk, complex conditions; attain visibility and care integration needed to address mental health issues; increase accountability among episodic care teams; and ease reporting by providing data, calculation and report submission services.

The Medecision Aerial platform is designed to connect, curate, direct and standardize data so the data integrates with existing technology and workflows. Aerial includes a unified clinical record – collected from real-time population and individual data across healthcare entities – that drives outcomes based on predictive analysis rather than retrospective review. Aerial can accept and process industry-standard data formats including HL7, CCD and EDI CMS, in real time or in batches. Data feeds between Aerial and providers, payers, employers and patients can enable real-time interaction with EHRs, PBMs, labs, medical devices, benefit administration systems and mobile devices.

Aerial includes an “intelligence engine” that aims to drive insights into new and better models for care delivery and quality. It includes population health analysis and benchmarking across test results, diagnoses, treatments, re-admissions and more to enable data-driven processes that identify and target specific patient populations needing special attention.

Intervention and engagement functionality in Aerial is designed to help provider organizations with coaching, care management and care coordination workflow. The platform includes tools to support a multidisciplinary care management program to optimize patient outcomes as well as alerts, workflow and wizards for streamlined interventions from care managers, coordinators and caregivers.

Aerial connects all of the players in a patient’s circle of care. The technology aims to be the foundation for an evidence-based approach to optimizing care while eliminating excessive treatment and expenses. Automatic referral management and authorization tools, for example, are tied to best practices-based workflows. At the core of this utilization management technology is a capability to apply business rules to determine automatically if a request for service is approved or pending. The Aerial platform also comes with configurable reporting tools that use analytics to track and measure performance, outcomes, compliance, costs and usage. This can help support strategic, administrative, clinical and regulatory requirements with visibility into the clinical, operational and financial success of a population management strategy.

Medicity offers a variety of systems that help provider organizations focus on population health management. Medicity Manage, for instance, is designed to help improve the effectiveness of care management, giving caregivers a comprehensive view of clinical information about each patient to help create appropriate and timely treatment plans. Medicity Manage gives care managers clinical insights such as health opportunities, noncompliance on quality measures, high-risk conditions and program recommendations.

Risk stratification is a key capability of Medicity Manage. Grouping patient populations by clinical program and stratified by risk can help organizations identify unique populations to engage. And standard registries – or custom registries based on quality measures, programs and alerts – can help organizations identify client-specific populations to engage.

With the Manage product, Medicity says an organization can: improve the quality of care through evidence-based clinical standards that provide the information caregivers need to create the right care plan for the right patient at the right time; advance population health goals by using claims and near real-time clinical data to identify at-risk populations for proactive intervention; identify gaps in care by learning which patients are not complying with treatment protocols; and streamline workflows by automating care management workflow to promote consistency, efficiency and effectiveness across a care management team.

On another front, Medicity Engage is designed to help provider organizations engage patients and provide access to data. The Engage technology facilitates secure messaging and clinical summary sharing between providers and patients, regardless of the patient portals or personal health records a healthcare organization uses.

Engage enables patients to interact with caregivers by securely connecting health information exchanges and hospitals to a patient’s chosen method of communication. The technology also provides access to authorized clinical information when patients make a request. Patients also can receive follow-up instructions from providers and view clinical summaries from any personal health record or patient portal.

Transcend Insights offers the HealthLogix Platform, which includes HealthLogix Populations, HealthLogix Care and MyHealthLogix. The platform is the underpinning of a scalable selection of population health and wellness components, both from Transcend Insights itself and from third-party developers. The HealthLogix platform is designed to work across organizations and silos of data to give users a shared perspective of healthcare information.

HealthLogix collects clinical, claims and wellness data from disparate systems to validate information for detailed analyses, ensuring multiple electronic health records systems within a community can exchange essential health information in real time. HealthLogix also provides proactive analytics, analyzing the combined information from a community to provide valuable insights to care teams in real time, aiming to empower teams to make confident decisions. HealthLogix is designed to identify everything from care gap alerts at the point of care to Big Data analytics across an entire population for proactive interventions. The HealthLogix platform uses Fast Healthcare Interoperable Resources (FHIR) technology to transfer data between health systems and third-party applications. It also leverages the RESTful application programming interface (API) for interoperability.

Wellcentive’s population health management platform is designed to help healthcare organizations track quality in a longitudinal fashion; measure and assess care across population segments; engage employed and affiliated providers; provide insight, reporting and measurement for both employed and affiliated providers; provide referral and network management capabilities and limit so-called network “leakage”; and optimize clinical, utilization and care outcomes across healthcare settings with the aim of driving improved revenue.

Wellcentive’s chronic care management technology offers tools that help analyze a provider organization’s patient data to determine CMS chronic care management opportunity; identify and enroll eligible patients; deliver and document required care management services using time-tracking features; and generate reports at any time to see which chronic care management patients have met the requirements for chronic care management billing.

Jiva for Value-based Care is an HIE-enabled population health management (PHM) platform that helps provider organizations meet ACO, Star, GPRO, PQRS, HEDIS and internal quality measures with an eye on maximizing revenue. The technology supports multiple accountable care organizations or value-based care initiatives on the same platform, and can help organizations maximize productivity, workflow and the decision-making process with actionable information that leverages data from EHRs, health information exchanges and other systems. It aggregates clinical, financial, administrative, and psychosocial data from disparate systems, including payers, hospitals, physician practices and post-acute providers.

Jiva for Performance Management helps organizations manage pay-for-performance contracts. Providers can use the technology to manage the clinical and financial performance of pay-for-performance and readmission-reduction programs across multiple payers – including Medicare, Medicaid and commercial contracts – and monitor progress toward Star, MSSP, HEDIS or other pay-for-performance goals. The technology can help providers gain insights into quality performance metrics for maximum revenue; identify and stratify highest-risk patients for better utilization of resources and admission risk reduction; understand patients holistically for more targeted engagement strategies leading to better outcomes; and assist with the transition to value-based reimbursement models.