Integrated Care Management for Complex Populations.
Give your care management teams a complete, real-time view of every high-risk member — with the workflows, alerts, and coordination tools to reduce hospitalizations, prevent readmissions, improve member engagement, and improve outcomes.
Know Every High-Risk Member Before the Crisis Hits
Effective care management is proactive, not reactive. EnsureCM™ combines claims, clinical, pharmacy, patient-reported, and social determinant data into a unified member profile — so your care managers can identify risk early, intervene appropriately, and coordinate care across the full continuum.
EnsureCM™'s Risk Stratification Engine combines three independently‑computed, industry‑standard layers — cost/financial risk, chronic condition burden, and near real‑time acute utilization — into a single, explainable composite risk tier, so care managers can prioritize their interventions where they matter most. From identifying the member discharged from the hospital yesterday to flagging the diabetic patient who has missed their insulin refill, EnsureCM™ surfaces the signals that matter — before they become expensive events.
Every Care Management Workflow, Unified
360° Member Health Profile
A complete longitudinal view of every member — claims history, clinical conditions, pharmacy utilization, open care gaps, hospitalization history, and care notes — in one interface.
Hospitalization Management
Real-time alerts for inpatient admissions, SNF placements, ER visits, and elective procedures. Full admission dashboard with LOS tracking and post-discharge follow-up workflows.
TCM & CCM Workflows
Structured Transitional and Chronic Care Management workflows that ensure post-discharge follow-ups happen within required timeframes, reducing readmissions and capturing billing opportunities.
Risk Stratification Engine
A 3‑layer, rules‑based engine combining cost‑risk scores, chronic condition burden, and near real‑time rising‑risk utilization signals (ED visits, admissions, various clinical risk assessment tools) into one explainable composite risk tier — complete with reason codes, so your highest‑risk members are never a black‑box score.
Task/Worklist Management
Auto-generated outreach tasks from risk scores, care gaps, or admission triggers — with assignment, prioritization, and SLA tracking for care managers.
Care Team Collaboration
Shared notes, @mentions, and handoffs between care coordinators, nurses, social workers, specialists, and PCPs.
Care Plan Builder
Auto-generates FHIR‑native care plans from a versioned library of condition templates, matched to each member's active conditions and risk tier via CDS Hooks & CQL, and routed to the care team for review before activation. Activated plans push discrete tasks straight into your worklist and give patients a connected portal to track goals and report progress.
Proactive Care Management Starts Here
See how EnsureCM™ gives your care management team the real-time intelligence to intervene earlier, reduce hospitalizations, and improve outcomes for your highest-risk members.