MANAGED CARE PLANS
Improve outcomes with a cloud-based integrated care platform
Go way beyond traditional care management
SyntraNet enables managed care organizations to extend into the community
Core Health Plan Functionality
Integrated Care Functionality
Interoperability with community data sources to get a 360 degree member view
Access for entire care team including community-based providers and government agencies
Coordination of Enhanced Care Management, Community Supports and LTSS
Collaboration and communication with entire care team
Assign tasks to care team members across systems
Leverage automation, collaboration tools, and configurable workflows
Predict risk, identify care and equity gaps, understand factors affecting outcomes, and flag opportunities for intervention.
Identify high-risk members
Analyze medical, behavioral, and social drivers of health to identify high-need members.
Configure care teams
Identify and create care teams and create role-based views for users.
Create care plans
Automate the creation of care plans based on evidence-based guidelines and enable customization based on specific needs.
Leverage smart workflows to ensure tasks and activities are assigned to the appropriate care team member.
Implement automated, configurable workflows and rules to create efficient authorization and referral processes.
Drive efficiencies in appeals and grievances processes
Implement appeals and grievances workflows that include worklists, due-date reminders, and notifications to improve member experience and comply with regulatory requirements.
Provide whole-person care
Integrate SDoH and behavioral health services to address both the clinical and social needs of members.
View reports and dashboards including outcomes, costs, and quality initiatives.
Dive deep with population health analytics
Identify risks, drive quality improvement, and achieve better health
outcomes across the entire population
Provider quality oversight
Track provider performance from a cost and quality perspective relative to their peers.
Quality management reporting
Access out-of-the-box reports or customize reports to meet your specific needs.
Care program enrollment recommendation engine
Implement a rules engine to automatically assign members to care management programs.
Care equity analysis
Leverage dashboards to analyze utilization and outcome data through a health equity lens.
Access SDoH, human services, and behavioral health data
Provide whole person care and meet NCQA Health Equity accreditation
Mental health encounters
Substance use disorder encounters
Behavioral health hospitalization and crisis utilization
Jail booking and release
Jail medical and behavioral health services utilization
Health and human services utilization
Community-based services utilization
Streamline utilization management
Leverage smart workflows driven by evidence-based guidelines to simplify utilization management and control costs while ensuring compliance.
Manage referrals to ensure members are seen by the right providers at the right time.
Automate workflows and rules to authorize services and referral requests.
Inform patients and providers of decisions with regulatory-compliant documentation.
Enable providers to submit authorization requests via a self-service provider portal.
Meet NCQA utilization management requirements.