MA plans, PBMs, and risk-bearing organizations act on Stars, HEDIS, and rising-risk before it escalates — grounded in resolved member context, not stale, fragmented signals.
Risk shows up late and scattered — across claims, pharmacy, and labs that reconcile months after the fact. Outreach fires on outdated lists, and the members who needed it most are already in the ED.
Payers compare members against the population, resolve the individual, and trigger the right action — with a clinician on the decision.
Formulary, benefit, and guideline logic ground every intervention in what's actually covered and indicated — no PHI, no BAA.
/knowledge/coverage/knowledge/guidelinesCompare a member to similar populations and pull their resolved, enriched view to see rising risk early. Population analytics is de-identified; member-level needs a BAA.
/context/population/context/memberClinician-approved process areas + integrations — rising-risk outreach, for example — that your agent calls via MCP, each built to defer the decision to your clinician.
/skillsMembers are compared against the population and resolved individually, so rising risk shows up sooner.
Coverage and guideline logic mean outreach is grounded in what's covered and clinically indicated.
Every recommendation is built to end with a human sign-off — outreach is targeted, never automated blindly.
Members get the right intervention sooner.
Tell us about your population and your Stars and HEDIS goals. We'll show you the knowledge, context, and skills that move them.