• Manage Transitions of Care
  • Identify socio-behavioral health determinants
  • Identify and manage high-risk patients
  • Stratify patient populations from aggregated data including EHRs, claims, registries, and EDWs
  • Automate the development of care plans derived from clinical and assessment data
  • Guide care team members to perform the right interventions for the right patients at the right time
  • Replace manual processes and disparate systems with a holistic management platform