Educational Health Content

GuidingCare has partnered with Healthwise to integrate evidence-based medical content into its care management technology platform. The integration injects high-quality clinical information into GuidingCare workflows to support care managers in educating and advising members. Care managers can also deploy health coaching and health education resources directly.

Social Determinants of Health

Through the GuidingCare integration with findhelp, care managers are provided instant access to comprehensive, localized listings with hundreds of programs in every ZIP code in the United States.

Social Determinants of Health

The GuidingCare platform integrates with Healthify’s infrastructure to help health plans more effectively address SDOH – nonclinical factors such as poverty, housing instability and food insecurity that impact health outcomes.

Clinical Criteria

GuidingCare has integrated the InterQual Connect medical review service into its utilization management (UM) module and Auth Portal for provider access, driving easier, faster, and more transparent prior authorizations in support of quality care.

Clinical Criteria

With CareWebQI’s integrated guidelines, GuidingCare customers can more effectively identify gaps in care and inform care strategies to improve patient outcomes.

Business Rules Engine

MCG Cite AutoAuth, integrated with GuidingCare’s Utilization Management module and Authorization Portal, allows health plans to leverage this capability and significantly reduce medical review turnaround times and overtreatment, as well as better apply staff resources.

Business Rules Engine

GuidingCare utilizes the FICO® Blaze Advisor® Business Rules Management System, a best-in-class rules engine that streamlines operations by automating business processes and workflows. The powerful rules engine allows GuidingCare customers to effectively manage complex care by leveraging multiple inputs, including data, member events, assessments, and pre-determined business rules for automation of best practices.

Lettering & Correspondence

Through partnership with SMARTComm, the GuidingCare platform features an Enterprise-level lettering solution that produce accurate, real-time correspondence for denials, appeals and grievances, as well as day-to-day welcome letters and other member personalized communications.

Lettering & Correspondence

Through partnerships with DevExpress, the GuidingCare platform features a Standard-level lettering solution for efficient creation of personalized member mailings that convey both professionalism and quality.

Risk Model: CDPS+Rx

CDPS+Rx is a logarithmic regression diagnostic (ICD-10 codes) and pharmacy (NDC codes) based predictive model grouper built using Medicaid claims data and therefore predicts most accurately the cost for Medicaid patients. CDPS+Rx is fully integrated into GuidingCare to be used alone or in combination with other risk measures to calculate a risk score representing the risk for future healthcare cost. GuidingCare has configuration available which assigns a stratification grouping to each member according to their score: critical, high, medium, or low risk.

Business Intelligence

The GuidingCare platform leverages Tableau for reporting and business intelligence and supports near real-time data processing that promotes operational and clinical business excellence. The Reporting & Business Intelligence module provides an easy-to-use, web-based user interface, offering more than 50 standard reports. This robust tool makes ad hoc report-building and analysis simple, so health plans can view the data that’s most critical to their business.