CareFlow
Close care gaps at population scale, automate prior authorizations, and drive measurable HEDIS and CMS quality improvement — powered by AI that understands each patient's entire clinical picture.
AI That Sees Every Patient's Full Clinical Picture — and Acts
CareFlow continuously monitors your entire patient panel, identifies individuals at risk, flags unresolved care gaps against HEDIS and CMS measures, and drives automated outreach and care coordination — all before a condition worsens or a quality metric fails.
- Real-time care gap identification across HEDIS, CMS, and custom measures
- Risk stratification scores updated with every clinical touchpoint
- Automated prior authorization submission and real-time status tracking
- AI-generated care plans with evidence-based intervention pathways
- Patient outreach workflows integrated with your care coordination team
Comprehensive Care Management Intelligence
From individual patient risk to population-level quality performance — CareFlow manages it all
Real-Time Care Gap Detection
Continuous monitoring of your panel against 100+ HEDIS and CMS quality measures. Automated gap identification with urgency scoring — so care coordinators focus on the patients who need intervention most, not data entry.
Prior Authorization Automation
AI-driven prior auth submission with payer-specific clinical criteria matching. 90% of authorizations submitted and tracked without manual intervention. Real-time approval status and escalation alerts for your team.
Clinical Risk Stratification
Dynamic patient risk scoring updated with every clinical touchpoint — lab results, encounter data, medication changes, and social determinants of health. High-risk patients surface automatically for immediate action.
Population Health Analytics
Aggregate-level insights into disease prevalence, care utilization, quality measure performance, and outcomes by cohort, provider, or care team. Identify systemwide patterns before they become systemwide problems.
Longitudinal Patient Tracking
Complete 360-degree patient history integrating EHR, claims, labs, pharmacy, and care management data. Track care plan adherence and clinical trajectory over time — catching deterioration before hospitalization occurs.
Automated Patient Outreach
Configurable care gap outreach via patient portal, SMS, and automated calls. Personalizes message content based on patient demographics, risk level, and health literacy — driving higher gap closure rates than manual outreach.
From Patient Risk Identification to Closed Care Gap
Identify Gaps & Risk
CareFlow ingests your complete patient panel data and continuously monitors against HEDIS, CMS, and custom quality benchmarks. High-risk patients and open care gaps surface automatically — prioritized by clinical urgency and financial impact.
Generate & Assign Care Plans
AI generates evidence-based care plans with specific, actionable interventions for each patient's risk profile. Prior authorizations are automatically submitted. Care coordinators receive actionable worklists — not raw data.
Track, Close & Optimize
Monitor care plan execution and gap closure in real time. CareFlow measures quality measure progress, updates risk scores with each intervention, and continuously optimizes outreach timing and channel for maximum patient engagement.
CareFlow transformed how we manage our Medicare Advantage panel. We went from scrambling to close gaps during open enrollment to having a continuous quality program running year-round. Our HEDIS composite improved by 11 points in 12 months — that directly impacted our star rating and bonus payments.
Results That Transform Your Quality Program
RAF Score Improvement
Identify and properly document all risk-relevant chronic conditions in your panel. Higher RAF scores translate directly to increased per-member revenue in value-based and Medicare Advantage contracts.
Prior Auth Automation Rate
Nine in ten prior authorizations submitted and tracked without manual staff intervention. Reduces administrative burden, speeds approval timelines from days to hours, and eliminates treatment delays.
Quality Measure Improvement
Systematic, AI-driven care gap closure drives accelerated improvement in HEDIS star measures — with compounding benefits in payer quality bonuses and network performance tiers.
More Patients Reached
Intelligent, personalized patient outreach achieves substantially higher engagement rates than manual calls. More patients completing preventive services means better outcomes — and better quality scores.
Transform Your Care Quality Program
See CareFlow live with your quality measures and patient panel. We'll identify your most impactful care gaps and show you a 12-month quality improvement roadmap.