Clinical Edge
Population Health Management
Population Health Management, part of Clinical Edge, helps health plans identify high-risk members, manage care transitions, and track quality measures to turn data into better outcomes.
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Gaps-in-Care Analytics
Identify high-risk members and surface health improvement opportunities with intuitive analytics that support Healthcare Effectiveness Data and Information Set (HEDIS®) and Star Ratings measures, so clinical teams can focus on proactive, preventive care.
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High-risk member identification
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Gaps-in-care insight
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Preventive care focus
Care Transition Management
Gain real-time visibility into inpatient events with workflows that trigger immediate, clinically appropriate interventions and keep members moving smoothly across care settings.
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Near real-time event visibility
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Timely clinical interventions
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Seamless cross-setting transitions
Quality Measure Tracking
Evaluate performance against federal and state compliance metrics, including HEDIS and Star Ratings, and tailor measures to specific population needs to drive better member outcomes.
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Performance benchmarking
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Population-specific measure configuration
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Full care team collaboration
Clinical Edge Suite
Care
Management
Streamlined workflows and centralized member data help care teams deliver personalized, evidence-based, whole-person care.
Utilization
Management
Clinically sound, workflow-driven tools with intelligent automation optimize the authorization lifecycle and support compliance.
Appeals
and Grievances
An intuitive, end-to-end solution consolidates appeals, supports regulatory compliance, and delivers one-click packet creation.
Authorization
Portal
End-to-end workflows, automated approvals, and real-time provider communications boost operational agility across your plan.
Mobile
Clinician
Secure mobile access lets field staff run assessments, build care plans, capture consent, and start referrals online or offline.
Member
Engagement
A scalable digital platform pairs omnichannel communication with advanced tools to deliver measurable health outcomes.
Population
Health
Real-time analytics and effective stratification identify at-risk populations and help your teams close care gaps faster.
Quality360
NCQA-certified quality management links HEDIS gap identification to care workflows, streamlining closure and reducing manual work.
Business Intelligence
Advanced reporting and dashboards for CMS and NCQA give your teams the insight to drive smarter, data-backed decisions.
Clinical Edge
University
24/7 access to module-based training, so staff can build product expertise on their own schedule, from anywhere.
Better Population Outcomes
Population Health Management part of Clinical Edge, turns member data into better outcomes across at-risk populations.