Quality Improvement

Comprehensive member satisfaction and quality management to address gaps in care. Optimizes overall quality measures.

CARE Smart™ is a seamless, prospective risk adjustment and member engagement service that enhances population health management, increases member satisfaction and addresses gaps in care. These proven technology tools and engagement activities allow healthcare organizations to increase revenue, improve quality ratings and strengthen plan-member relationships.

Members can be difficult to reach and engage with and some individuals are resistant to seeing their physician or unwilling to embrace healthy habits. Healthcare providers may be unable to identify or engage with these populations with the highest health risks. Additionally, the challenge in navigating complex member programs can be critical for financial success.

The CARE Smart program components include:

  • Data Analytics
  • Community Service Program Enrollment Assistance
  • Member engagement service
  • Prepare Healthcare Providers Physicians For Effective Visits/Interaction
  • Coordinate In-Home Health Assessments
  • Patient Follow-Up
  • Coding Accuracy Check and Quality Assessment
  • Care Management Continuity Assistance
  • Claims Coding Verification

CARE Smart produces real results. Health plans are able to ensure member charts and claims are accurately coded, identify loses in Hierarchical Category Condition (HCC) or Medicaid Risk Scores due to missing diagnosis in the past year, improve risk profile and member retention, and enhance Health Reimbursement Agreement (HRA) compliance, healthcare outcomes and quality improvement.

Leverage all or some of the CARE Smart tools with your existing quality improvement or care management program:

  • SMART Connect™ is a multi-channel, interactive healthcare communication platform delivers automated health education and member engagement to ensure timely, appropriate care and increased plan member satisfaction.
  • SMART Appointment Scheduling™ is a member engagement service that allows health plans to strengthen a member’s relationship with their Primary Care Physician while closing gaps in care and, in turn, receive accurate reimbursements.
  • COMMUNITY Link™ is a social advocacy service that provides health plan members information and access to more than 7,500 public and privately sponsored community programs for which they may be eligible.


  • Member Outreach & Engagement
  • Care Management Enhancement
  • Provider Evaluation Reporting