Population Health | Healthcare worker explaining over clipboard to doctor at hospital

Clinical Care Management

Care management is a journey, and we’re there every step of the way

Care isn’t a one-time thing—it’s a journey. By combining AI data-driven communication campaigns with physician-guided clinical care management, you can support your most vulnerable high-cost claimants and members with chronic conditions while lowering your medical cost trend.

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NCQA Accredited - Population Health Program

NCQA-certified and accredited data-driven clinical support and care management

Our Clinical Care Management program targets high-risk and at-risk members using a multi-channel approach that combines advanced data analytics with proactive outreach, intense clinical interventions, and care management. Keep reading to see how it works.

Clinical Care Management | Data-driven clinical support

Health Advocate has NCQA Population Health Program accreditation for our Clinical Care Management program, for our clinical support addressing asthma, diabetes and hypertension.

Health Advocate also has NCQA certification for the Healthcare Effectiveness Data and Information Set (HEDIS) measures for our Health Insights Dashboard™, a certification we have held for seven consecutive years.

Using data to identify those at risk

Proactively engaging members through targeted outreach

Nurses personally coach members one-on-one

Providing ongoing care coordination

Health Advocate has NCQA Population Health Program accreditation for our Clinical Care Management program, for our clinical support addressing asthma, diabetes and hypertension.

Health Advocate also has NCQA certification for the Healthcare Effectiveness Data and Information Set (HEDIS) measures for our Health Insights Dashboard™, a certification we have held for seven consecutive years.

Risk identification

We can identify over 1,700 gaps in care using data from:

Clinical Care Management | Mobile Screenshots

Data-driven proactive outreach

Condition management is transformed by advanced data analytics

Once we’ve identified the high-risk and high-cost claimants within your organization, we conduct targeted outreach to encourage them to engage with our experts, who then help close gaps in care.

Sending mobile and web-based alerts, plus home mailings, gets members to engage with us and take action.

Request a demo

Data-driven proactive outreach

Condition management is transformed by advanced data analytics

Once we’ve identified the high-risk and high-cost claimants within your organization, we conduct targeted outreach to encourage them to engage with our experts, who then help close gaps in care.

Sending mobile and web-based alerts, plus home mailings, gets members to engage with us and take action.

Request a demo

Nurse coaching & care management

Once eligible members engage with us, our nurses begin the assessment and care planning process, including a detailed clinical intake to identify each member’s risks and needs.

Our nurses consult with our internal medical team to create personalized care plans, establish ongoing coaching schedules, and ensure members are connected with appropriate third-party resources. They also provide lifestyle and behavioral health coaching, treatment decision support, health education, and pre-service clinical and benefit navigation support.

Clinical Care Management | Nurse Coaching

Nurse coaching & care management

Once eligible members engage with us, our nurses begin the assessment and care planning process, including a detailed clinical intake to identify each member’s risks and needs.

Clinical Care Management | Care Coordination

Ongoing care coordination

We provide ongoing coordination and continuity of care, working with the member as long as necessary for whatever they need.

Answering questions
Reviewing care options
Consulting and coordinating care and services
Locating and arranging expert second opinions
Facilitating pharmacy, medical equipment and prior authorization requests
Coordinating clinical services prior to and after outpatient treatment and hospital stays

Ongoing care coordination

We provide ongoing coordination and continuity of care, working with the member as long as necessary for whatever they need.

Answering questions
Reviewing care options
Consulting and coordinating care and services
Locating and arranging expert second opinions
Facilitating pharmacy, medical equipment and prior authorization requests
Coordinating clinical services prior to and after outpatient treatment and hospital stays