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AI: A game-changer for Medicare patients

Artificial intelligence (AI) has emerged as a game-changer in revolutionizing healthcare for Medicare patients. By harnessing the power of AI technologies, healthcare providers can deliver personalized, efficient, and effective care, addressing the unique needs of everyone. Here are some keyways in which AI is transforming care for Medicare patients:


Early Detection and Prevention: One of the crucial aspects of healthcare for Medicare patients is early detection and prevention of diseases. AI-driven algorithms can analyze vast amounts of patient data, including medical records, laboratory results, and genetic information, to identify patterns and markers that may indicate potential health risks. By detecting these risks early on, healthcare providers can intervene proactively, implement preventive measures, and ultimately reduce hospitalizations and improve patient outcomes.


Precision Medicine: Every patient is unique, and their healthcare needs may vary. AI algorithms can analyze individual patient data, including medical history, genetic factors, lifestyle, and demographics, to develop personalized treatment plans. This approach, known as precision medicine, ensures that Medicare patients receive tailored therapies and interventions that are most likely to be effective for their specific condition. This not only improves patient outcomes but also reduces unnecessary medical procedures and medications, leading to cost savings.


Efficient Diagnosis and Medical Imaging: Timely and accurate diagnosis is paramount in providing quality healthcare to Medicare patients. AI-powered diagnostic tools can analyze medical images, such as X-rays, MRIs, and CT scans, with high accuracy and speed. These tools can assist healthcare professionals in detecting abnormalities, identifying potential diseases, and making more precise diagnoses. By reducing the chances of misdiagnosis or delayed diagnosis, AI technology improves patient prognosis and enables timely initiation of treatments.


Remote Patient Monitoring: Managing chronic conditions and ensuring patient compliance with treatment plans are ongoing challenges in caring for Medicare patients. AI enables remote patient monitoring through wearable devices and mobile applications that collect real-time health data, such as heart rate, blood pressure, and glucose levels. Healthcare providers can remotely monitor patients' health status, assess changes or abnormalities, and intervene when necessary. This not only improves patient convenience but also reduces the need for frequent hospital visits, ultimately lowering healthcare costs.


Predictive Analytics and Population Health Management: AI algorithms can analyze large datasets and identify patterns that may predict health risks or complications for Medicare patients. By leveraging predictive analytics, healthcare providers can identify individuals at higher risk of developing certain conditions or experiencing adverse events. This enables targeted interventions, such as lifestyle modifications or preventive screenings, to mitigate these risks and improve patient outcomes. Moreover, AI-powered population health management systems can analyze demographic data, disease prevalence, and healthcare utilization patterns to better allocate resources and improve overall healthcare delivery.


Enhanced Patient Engagement and Education: AI-powered virtual assistants and chatbots can provide Medicare patients with real-time, personalized health information and support. These virtual nurse assistants can answer questions, provide medication reminders, and offer lifestyle recommendations, promoting patient engagement and adherence to treatment plans. By empowering patients with knowledge and resources, AI technology fosters active participation in their own healthcare, leading to improved health outcomes. We offer these services at EmpowerHealth, and would love for you to learn more about how we can positively impact your patient population.


The integration of AI in healthcare has the potential to revolutionize care for Medicare patients. From early disease detection to precision medicine, remote patient monitoring, and predictive analytics, AI offers immense opportunities to enhance patient outcomes, improve efficiency, and reduce healthcare costs. As healthcare providers continue to embrace AI-driven technologies, the future of healthcare for Medicare patients looks promising, with personalized, timely, and effective care at the forefront.

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AI-Enabled Decision Support Systems: Ensuring Quality and Safety in Healthcare

One significant way in which AI is transforming care for Medicare patients is through the development and implementation of AI-enabled decision support systems. These systems utilize advanced algorithms and machine learning techniques to assist healthcare providers in making informed clinical decisions, improving the quality and safety of patient care.


AI decision support systems can analyze vast amounts of patient data, including medical records, lab results, imaging studies, and clinical guidelines, to provide evidence-based recommendations and treatment options. By leveraging this wealth of information, healthcare providers can deliver personalized and precise care to Medicare patients, taking into account their unique characteristics, medical history, and comorbidities.


These systems can assist healthcare providers in several ways:

Accurate Diagnosis: AI algorithms can aid in the diagnostic process by analyzing patient data and identifying patterns or anomalies that may indicate specific conditions or diseases. By incorporating machine learning models trained on a vast array of medical cases, AI decision support systems can enhance the accuracy and speed of diagnoses, reducing the occurrence of misdiagnosis or delayed diagnosis.


Treatment Planning: AI decision support systems can help healthcare providers develop individualized treatment plans for Medicare patients. By considering various factors such as age, medical history, genetics, lifestyle, and comorbidities, these systems can suggest tailored treatment options, medication regimens, and preventive interventions. This personalized approach not only improves patient outcomes but also reduces the risk of adverse drug events and unnecessary treatments.


Medication Management: Medication errors and adverse drug events are significant concerns in healthcare, particularly for Medicare patients who often take multiple medications. AI decision support systems can assist healthcare providers in prescribing the appropriate medications, considering factors such as drug interactions, contraindications, and dosage adjustments based on renal or hepatic function. These systems can also provide real-time alerts and reminders to healthcare providers, improving medication safety and adherence.

Clinical Decision Making: AI decision support systems can analyze patient data, medical literature, and clinical guidelines to provide evidence-based recommendations for specific clinical scenarios. For example, these systems can help healthcare providers determine the most appropriate diagnostic tests or imaging studies for a particular patient, interpret test results, or guide the management of complex medical conditions. By incorporating the latest advancements in medical knowledge and research, AI decision support systems support healthcare providers in making well-informed decisions.


Risk Stratification and Predictive Analytics: By analyzing patient data from various sources, including electronic health records, wearables, and genetic information, AI decision support systems can identify Medicare patients at higher risk of developing complications, hospital readmissions, or adverse events. These systems can provide predictive analytics, enabling proactive interventions and preventive measures to mitigate these risks. By stratifying patients based on their risk profile, healthcare providers can allocate resources efficiently and optimize care delivery.


In summary, AI-enabled decision support systems have the potential to significantly enhance the quality and safety of care for Medicare patients. By leveraging AI algorithms and machine learning techniques, these systems can assist healthcare providers in accurate diagnosis, personalized treatment planning, medication management, clinical decision making, and risk stratification. As healthcare continues to integrate AI-driven technologies, the future of care for Medicare patients looks promising, with improved outcomes, reduced healthcare costs, and enhanced patient experiences.

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Revolutionizing Healthcare: Exploring the Future of Patient Population Management

In the ever-evolving field of healthcare, one aspect that has garnered significant attention in recent years is patient population management. It’s one of the primary use cases of EmpowerHealth, as we manage patient populations for providers, Heath Systems and Health plans. With the increasing prevalence of chronic diseases and an aging population, healthcare providers are faced with the challenge of managing a larger number of patients and ensuring their well-being. The future of patient population management lies in revolutionizing traditional healthcare approaches through the implementation of advanced technologies and data-driven strategies. This article will explore the transformative potential of patient population management and its implications for the future of healthcare.


The importance of patient population management 


Patient population management plays a crucial role in healthcare today and will continue to be of utmost importance in the future. As the prevalence of chronic diseases continues to rise and the population ages, healthcare providers are tasked with managing a larger number of patients and ensuring their well-being. 


One of the key reasons why patient population management is essential is its ability to improve the quality of care provided to patients. By taking a proactive approach and implementing data-driven strategies, healthcare providers can identify high-risk patients, monitor their health conditions, and intervene early to prevent complications or hospitalizations. This not only improves patient outcomes but also reduces healthcare costs by minimizing the need for expensive treatments or emergency services.


In addition, patient population management enables healthcare providers to optimize resource allocation and enhance operational efficiency. By gaining insights into the specific needs and characteristics of their patient population, providers can tailor their services and allocate resources more effectively. This ensures that patients receive the right level of care at the right time, minimizing unnecessary visits or hospitalizations and maximizing the efficiency of healthcare delivery.


Furthermore, patient population management facilitates the implementation of preventive care measures and population health initiatives. By analyzing population data and identifying common risk factors or trends, healthcare providers can develop targeted interventions, educational campaigns, and preventive strategies. This proactive approach not only improves individual health outcomes but also has a positive impact on the overall health of the population, leading to a healthier society.


Lastly, patient population management is crucial for improving care coordination and collaboration among healthcare providers. By implementing advanced technologies and data-driven systems, providers can securely share patient information, coordinate care plans, and facilitate seamless transitions between different healthcare settings. This ensures continuity of care, reduces medical errors, and enhances the overall patient experience.


In conclusion, patient population management is of utmost importance in healthcare, both now and in the future. By implementing advanced technologies, data-driven strategies, and proactive interventions, healthcare providers can improve patient outcomes, optimize resource allocation, implement preventive care measures, and enhance care coordination. With the transformative potential of patient population management, the future of healthcare holds great promise for improved healthcare delivery and improved patient well-being.

To find out more about how we can help save costs and improve the efficiency of managing your patient population, schedule some time with the team at EmpowerHealth here.

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Care Angel Launches Offering to Support Managed Care Plans Charged with Medicaid Redeterminations

MIAMI--(BUSINESS WIRE)--Care Angel, the leader in AI digital health engagement, announces today its offering to support health insurers in maximizing outreach efforts to recertify the nation’s estimated 91 million Medicaid members. The company’s offering is announced amidst the unwinding of the public health emergency, which had allowed for the continuous enrollment of members.

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The end of the public health emergency, which was announced in January 2020 in response to the COVID-19 pandemic, now requires health insurers with Medicaid plans to begin eligibility redeterminations, effective April 1. At risk are the tens of millions of Medicaid members who may lose their benefits if they’re not determined eligible or have missing or incomplete information.

Care Angel offers well-timed, personalized conversations that support health insurers’ cost-containment, revenue retention, and labor-shortage mitigation efforts. Campaigns can be executed quickly and in alignment with Centers for Medicare & Medicaid Services guidelines. Angel, the company’s AI digital health engagement platform, strategically maximizes outreach, while accommodating the preferences and communication needs of Medicaid beneficiaries for phone, text, or secure chat in more than 72 languages.

Angel’s engagement captures members’ household information updates, such as mailing address, employment, income, health, and risk status. The company’s offering is deployed within a secure platform that supports HIPAA compliance.

“Care Angel is uniquely positioned to provide this capability to health insurers, many of which plan to conduct 10 or more touchpoints per beneficiary over the next year,” says Bud Flagstad, chief executive officer at Care Angel. Flagstad spent nearly 16 years in executive leadership roles at UnitedHealth Group.

“We are currently working with large health plans in support of their collective outreach efforts to contact members, in their language, using their preferred method of communication, which includes text as an essential channel,” he adds.

Care Angel deploys solutions that help payers, in addition to providers, health systems, and traditional and virtual healthcare delivery organizations, improve the patient experience and maximize the use of scarce resources.

 

 

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Care Angel's Payer Client Nets $62M in Clinical and Operational Savings Over 18 Months

MIAMI--(BUSINESS WIRE)--Care Angel, the leader in AI voice-enabled, nurse assistant technology that proactively identifies and addresses patient care gaps to improve outcomes for whole populations, announces today that one of the nation’s largest payers generated $62 million in clinical and operational savings from 2021-2022 as a result of its partnership with the company. With Angel, the company’s digital health engagement platform, the large national payer extended clinical capacity by 600 times, while achieving $49.3 million in readmissions savings and $12.7 million in reduced labor costs.

Angel surfaces the members who need access to resources, information, or clinical support in real time. The multimodal platform, which is accessible by voice, text, and chat, supports payers and providers by increasing patient engagement, which means greater reach without the added labor costs.

Conversely, with a fully in-sourced nurse call center, payers reach approximately 10% of members—and at a higher cost—in an effort to surface care gaps. With Angel, payers have access to a proven machine-learning platform, informed and trained by clinical experts for more than six years. As a result, payers of all sizes can dramatically increase clinical capacity, without adding labor costs, which supports nurses and care managers working at the top of their licenses.

“Payers understand that simply employing more nurses at call centers isn’t going to provide members with the continuous support they need to inform more effective care at scale, while driving positive outcomes,” says Bud Flagstad, chief executive officer at Care Angel. Flagstad spent nearly 16 years in executive leadership roles at UnitedHealth Group.

“Angel is a data-driven platform that helps deliver high touch experiences to bend the cost curve while ensuring faster, easier access to care with the appropriate interventions,” he adds. “We’re thrilled to support one of the nation’s largest payers in engaging with millions of patients. The result is a dramatic reduction in call center costs and the proactive identification and addressing of care gaps in real time for whole populations.”

Care Angel deploys solutions that help payers, in addition to providers, health systems, and traditional and virtual healthcare delivery organizations, improve the patient experience and reduce avoidable readmissions.

 

 

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Care Angel and Upside Partner to Offer AI-Driven Housing and SDOH Benefit to Health Insurers

MIAMI & FT. LAUDERDALE, Fla.--(BUSINESS WIRE)--Care Angel, the leader in AI voice, nurse assistant technology that proactively identifies and addresses care gaps to improve outcomes for whole populations, and Upside, the only fully managed living option for older adults creating a new category of senior living, announce today a partnership to offer a comprehensive health-risk assessment and housing intervention solution to health insurers.

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This new offering will provide health insurers with actionable intelligence about their members at low, moderate, or high risk for factors such as chronic conditions, lack of medication adherence, preventative care, and social determinants of health (SDOH) measures such as housing.

One in five Americans is projected to be 65 years of age or older by 2030, according to the U.S. Census. A triggering event – which can include one of the “5 Ds,” a death, downsizing, divorce, disaster, or disability – can drive the need to seek new housing. But many seniors lack a full-time support network to help them navigate finding a new home that meets their specific social engagement and health needs. Health insurers are typically unaware that their members are going through these life transitions, and this lack of awareness about their members can contribute to poor health outcomes.

While many health insurers have invested resources in data mining to better understand their members’ needs, where they need greater insight is in understanding their members’ SDOH risks, in particular with housing. Through the Care Angel-Upside partnership, health insurers will have the intelligence they need to predict individual members’ SDOH risks more accurately and respond to their most pressing needs.

“Health insurers continue to curate and mine data, while adding benefits for Medicare Advantage members, but data fragmentation and point solutions often lead to missed care opportunities,” says Bud Flagstad, chief executive officer at Care Angel. “By pairing our highly scalable consumer engagement service with the deep expertise and network of nearly 2,500 communities nationwide, the Care Angel-Upside partnership seamlessly integrates a much needed service to ease the transition to appropriate housing support. With this partnership, the two companies will deliver on health insurers’ need for real-time, secure, scalable, granular-level detail of members’ SDOH, as a result of Angel’s personalized and proactive conversations with members.”

“As we continue to grow the size of our communities and expand into new markets, we’re constantly auditing our offerings to ensure we’re anticipating our members’ needs,” says Upside co-founder Jake Rothstein. “Through our partnership with Care Angel, we’re not only able to remain competitive within the industry – creating a lifestyle that isn’t available through traditional senior living models – but we’re also showing our current and future members that we’re looking to grow older with them and offer support that evolves with their needs.”

The combined offering is currently available in 97 markets across 42 states. By early 2023, it’s expected that the offering will be available in all 50 states.

Note to editors: Nick Martin, chief information officer and EVP of product at Care Angel, and Jake Rothstein, co-founder at Upside, are available to discuss this partnership, in addition to seniors’ SDOH needs, in particular with housing. Nick and Jake will also be at HLTH in Las Vegas from Nov. 13 to 16.

About Care Angel: Founded in 2016, Care Angel is the leader in AI voice, nurse assistant technology that proactively identifies and addresses care gaps to improve outcomes for whole populations. The company provides Angel, a patient-focused digital health engagement service that helps individuals maintain health and well-being, close gaps in care, and improve outcomes.

About Upside: Upside is the only fully managed living option for older adults and is an entirely new category of senior living. The company utilizes modern apartments in vibrant, safe, amenity-rich apartment communities and provides a turnkey and frictionless living experience for those who desire simplified living, later in life.

 

 

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Patient-Centric Healthcare Requires a Brand-New Approach to Personalized Engagement

Let's address the elephant in the room rather than continuing to ignore it: traditional patient and member engagement methods are no longer sufficient. Despite their once-perceived actionable impact, postcards, emails, and notification-driven smartphone-based apps fail to deliver meaningful outcomes for patients and members.

It's clear that we need to embrace a member- and patient-centric approach—one that prioritizes personalized engagement to improve clinical outcomes while reducing healthcare and operational costs.

Challenging the status quo: rethink traditional engagement

The limitations of conventional engagement methods are glaring. Beyond the exorbitant costs of postcards and smartphone apps, these approaches are ineffective.

Whether it's about engaging high-utilizers or reaching Medicare populations, the absence of meaningfully designed engagement is palpable. It also reduces satisfaction and care quality while continuing to contribute to high healthcare costs for all stakeholders.

We must improve health outcomes and lower healthcare costs while reducing operational spending so that all stakeholders can benefit. To achieve this, let’s boldly re-imagine our approach to patient and member engagement.

Embracing innovative healthcare communications: Meet members and patients where they are.

Imagine having an unlimited number of call center employees reaching every member or patient for several different personalized reasons at a fraction of the cost. Imagine boosting engagement among members and patients by 8 to 12 times at a fraction of the cost. Finally, imagine opening up capacity for your nurses and care managers by a minimum of 600%.

Imagine!

Here’s the reality: a lot of healthcare happens at home, especially for older adults who often deal with significant health issues. So, connecting with them where they're most comfortable only makes sense.

But instead of inundating people with generic communications, let's tailor our engagements to their individual needs and contexts and in the languages they speak. By adopting strategies that include proactive, outbound check-ins, we can establish deeper connections with members and patients by empowering them to navigate their health journey with confidence and autonomy.

The challenge: healthcare spending goes up while quality, satisfaction, and outcomes go down

Imagine a 70-year-old man struggling with multiple comorbidities, food insecurity, and the inability to afford his medications. With conversational AI, we can promptly identify gaps and connect him with community resources and support services. Informed by guided conversation that produces rich data, this personalized support is available to Medicare Advantage, Medicaid, and Commercial populations.

What results should we expect? Care gaps getting addressed immediately, the delivery of preventive care, and improved wellness over time. We can now reduce this older adult’s risk of health complications. And ultimately, we can lower overall healthcare costs when this approach is used across populations of patients and members.

Transforming chronic care: technology is the driver

Similarly, members and patients managing chronic conditions like diabetes who have access to Medicare Advantage, Medicaid, or Commercial health insurance will benefit from faster access to precise and tailored resources.

With conversational AI, we can collect and process large amounts of data quickly to provide personalized communication via multiple channels—be it text, phone, or chat. From increasing benefit awareness and enrollment to supporting chronic condition management and everything in between, personalized engagement empowers members and patients to make informed decisions, leading to improved health outcomes—at demonstrably lower costs.

A call to action: embrace the future

It's 2024. We must wholeheartedly embrace this member- and patient-centric mindset. Let's move on from outdated methods and invest in solutions that speed up resolution time for members and patients, saving everyone time and money. By prioritizing regular outreach and connections, we can make personalization and automation the new standard.

What I love about EmpowerHealth is our commitment to identifying, educating, activating, and continuously managing and monitoring individuals' health journeys. With our innovative AI-enabled digital health assistant, informed by rich data and clinical feedback, we ensure that each member or patient has an experience that's intuitive, trusted, reliable, scalable—and above all, personal.

It might sound complex, but we're simply checking in on members and patients to help them achieve wellness.

Embrace a shift toward personalized care.

Let's embrace the use of data to create a better experience for members and patients—and a rapid shift towards personalized, proactive engagement. Together, we can shape a healthcare landscape where every member or patient gets the tailored support they deserve—empowering them to lead healthier, happier lives—and reducing healthcare costs for all of us.

What does it mean to empower members and patients?

Empowering members and patients means helping them feel like they have a real say in their health. It's about believing they can tackle their health problems and control their health conditions and the life circumstances that affect their well-being.

Written by Nick Assad. Nick is vice president of sales at EmpowerHealth.

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The Data Revolution: Analytics Expertise Takes Center Stage in Managed Medicaid

The spotlight is on population health capabilities among health insurers. For proof, look no further than recent Requests for Proposals (RFPs) from state Medicaid programs that emphasize two key areas: health equity and social determinants of health. That’s according to reporting by RADAR on Medicare Advantage.

Six states, impacting approximately 11 million lives, have signaled a shift in managed care by adding new populations. Specifically, states are urging the integration of behavioral health, Managed Long-Term Services and Supports (MLTSS), and pharmacy services into acute care.  

For instance, Georgia is set to transition its older, blind, and differently abled Medicaid population to managed care, while Virginia aims to consolidate MLTSS and managed Medicaid plans. These changes underscore the imperative for insurers to adapt to evolving Medicaid needs.  

Analytics expertise in demand  

State Medicaid agencies are seeking improved capabilities among health insurers. The focus is on insurers equipped with tools to track outcomes and streamline processes, which recognizes data's crucial role in enhancing managed Medicaid efficiency. 

Centene Corp.'s CEO, Sarah London, highlighted this trend, telling RADAR on Medicare Advantage about the significance of Georgia's RFP, which includes the state's aged, blind, and differently abled population. The evolving managed Medicaid landscape presents challenges and opportunities for payer executives. Increased RFP activity and new population inclusions call for a strategic approach among health insurers. 

To thrive, payers must prioritize innovation, invest in advanced analytics, and align services with evolving Medicaid needs.  

Enter EmpowerHealth. Payers across the nation rely on our platform to keep members on track with their care plans and bridge crucial care gaps. Our promise? Elevate quality, drive improvements in Stars and HEDIS measures, and ensure members achieve health and well-being. 

Why EmpowerHealth? One major national payer client slashed a whopping $62 million in clinical and operational costs over just 18 months. 

We're revolutionizing engagement and simplifying navigation, and boosting member education—all while helping to reduce the cost of care.  

Let's talk today! 

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Medicaid Directors Expect Medicaid Enrollment to Drop by Almost 9%

A sharp drop in Medicaid enrollment–of 8.6%–is expected in 2024, according to reporting by The Hill. Of course, the larger context is the Medicaid unwinding that started with the end of the public health emergency in May.  

The drop in Medicaid enrollment is just one pain point revealed in a recent KFF survey of the nation’s Medicaid directors. 

Here are 4 more learnings about the Medicaid unwinding from the KFF survey: 

  1. 1. More than 1 million low-income people no longer have access to Medicaid, as of November 8. 

  1. 2. At least 2 million children (likely an undercount) have lost Medicaid coverage. 

  1. 3. More than 70% of people lost Medicaid coverage due to procedural reasons, such as state officials’ mistakes or lost paperwork. 

  1. 4. State spending on Medicaid is expected to increase by 17% next year as a result of the phasing out of federal financial assistance. 

While Medicaid directors attempt to contend with these and other realities, they’re also faced with workforce challenges. In a recent KFF webinar, Amir Bassiri, deputy commissioner of the Office of Health Insurance Programs and New York State Medicaid director, and Jennifer Strohecker, Medicaid director, Utah Department of Health and Human Services, pointed to labor shortages as a top issue they’re facing and expect to contend with in 2024. 

To help address these and other challenges, EmpowerHealth supports Medicaid managed care organizations (MCOs) in achieving ambitious targets by:   

  • Addressing labor shortages and economic impact 

  • Rapidly identifying members and patients with outdated contact information 

  • Confirming mailing address and other contact details for members and patients 

  • Driving SDOH efforts 

  • Educating members and patients on how and why to re-enroll  

  • Sending text messages with education and other resources 

  • Improving program enrollment efficiency and outcomes 

MCOs around the country rely on Angel, an AI-assisted engagement service developed by EmpowerHealth that is purpose built to drive improvements in health and well-being. Some of the nation’s largest health organizations partner with EmpowerHealth to boost communications, help close care gaps, mitigate risks, and improve clinical and operational outcomes. 

One of our large national payer client’s netted $62 million in clinical and operational savings over 18 months.   

We’re optimizing engagement, navigation, and education for our clients, while reducing the cost of care. By identifying and addressing care gaps in real time, our clients capture care opportunities and boost quality, while improving intervention for members and patients who need it.  

Let’s talk today!  

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