Clinical Decision Management

Care360™ Clinical Decision Management uses industry-leading predictive modeling technology, combined with critical data sets including medical and pharmacy claims and laboratory results, to help you proactively identify high-risk members so your disease and case management programs can intervene effectively before a high-cost incident is incurred. Care360 Clinical Decision Management not only identifies who is at significant risk, it also identifies what is driving their risk and highlights any gaps in their care.

Via the Care360 Physician Portal, Physicians can now be effectively engaged in the care management process through sharing of clinical data, disease state identification of their patient population, and compliance reporting against pertinent clinical guidelines.

Care360 Clinical Decision Management offers:

• Analysis based on claims, pharmaceutical history and lab results
• Stratification of patient based on projected risk
• Gap reporting against evidence-based guidelines
• Physician, employer and member-centric reporting

Benefits:

• Maximize intervention efforts using the most accurate high-risk methodology available.
• Improve operations and set competitive premium rates with superior medical expense forecasting.
• Engage your physician network in your care management process through the Care360 network.
• Increase patient and physician satisfaction by providing clinically relevant, actionable information.