Medicare AdvantageValue-Based CarePopulation HealthRisk Adjustment

Managed Care

Medicare Advantage & Value-Based Care

Managed Care is a population health and value-based care operations platform designed for Medicare Advantage organizations, delegated provider groups, ACOs, CINs, and care-management programs. It combines member engageme...

v2.3.1HealthCloud Solutions StudioUpdated 3 days agoFHIR R4 CompatibleDeployable Solution

Composable Asset Stack

Deployed by

42
organizations
worldwide
Published by HealthCloud Solutions Studio Verified PublisherView Publisher Profile
Runs OnHealthCloud OSFHIR R4SMART on FHIRAI Orchestration RuntimeSafeCDx Compatible

Deployment Summary

5–14 days
Deploy Time
12+ R4 types
FHIR Resources
6
Agents Included
6 core
Workflows
4 categories
Integrations
7 modules
Compliance

Population Health and Value-Based Care Operations

Managed Care is a population health and value-based care operations platform designed for Medicare Advantage organizations, delegated provider groups, ACOs, CINs, and care-management programs. It combines member engagement, longitudinal risk management, care gap closure, diagnostics coordination, chronic condition workflows, utilization oversight, and operational reporting into a deployable value-based care experience.

What This Deploys

Medicare Advantage and chronic care engagement workflows
Risk stratification and care gap management operations
Diagnostics, preventive care, and longitudinal outreach programs
Population analytics and utilization management dashboards

High-Level Flow

Identify

Members are stratified using risk, utilization, chronic conditions, and preventive care gaps.

Population Risk Agent

Engage

Outreach, intake, assessments, and longitudinal care workflows are initiated.

Member Engagement Agent

Coordinate

Care plans, diagnostics, referrals, telehealth, and monitoring workflows are assigned.

Care Coordination Agent

Monitor

Adherence, utilization, preventive care, and chronic condition metrics are tracked.

Longitudinal Monitoring Agent

Escalate

High-risk, rising-risk, or non-compliant members are routed to intervention queues.

Clinical Escalation Agent

Report

Quality, utilization, and operational dashboards are updated continuously.

Population Reporting Agent

Key Modules

Risk Adjustment Operations

Longitudinal workflows supporting risk visibility and chronic condition management.

RiskChronic CarePopulation

Care Gap Closure

Identification and outreach for preventive screenings, diagnostics, and wellness engagement.

PreventiveOutreachQuality

Chronic Care Programs

Integrated workflows for diabetes, cardiac health, hypertension, and complex care.

Chronic CareRPMMonitoring

Utilization Oversight

Monitoring workflows for utilization patterns, escalations, and operational intervention.

UtilizationOperationsAnalytics

Care Navigation

Telehealth, diagnostics, referrals, transportation, and follow-up coordination.

NavigationCoordinationCare

Population Reporting

Executive dashboards for payer, provider, employer, and delegated-risk organizations.

ReportingExecutivePopulation

Clinical Reliability

  • Population stratification improves intervention prioritization
  • Care-gap workflows support preventive engagement
  • Operational dashboards improve visibility across large member populations
  • FHIR-ready structures support interoperability with payer and provider systems
  • Escalation workflows separate routine outreach from high-risk intervention

Compliance Modules

HIPAA-ready UI patterns FHIR R4 resource mapping Consent capture Role-based access control Audit logging Population health workflow governance Care management operational support

Pricing & Enablement

Population health enablement

Includes member engagement workflows, care coordination, chronic condition monitoring, operational analytics, and population reporting dashboards.

MA ReadyPopulation Health EnabledValue-Based Care Focused