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About the Care Management Framework

Updated on September 25, 2019


The Care Management Framework (CMF) is a rules-based, patient-centric care management solution that optimizes the creation and management of care plans to members through automated integration and workflow rules. Designed expressly for the growing requirements of today’s healthcare organizations, CMF provides a unified approach that leverages the value of highly skilled care management professionals to ensure that optimal care is delivered to both populations and individuals across chronic and acute conditions for whole person care.


  • 360°member-centric composite display with current, critical data pulled from relevant disparate sources across multiple programs
  • Proactive management of care plans using alerts that monitor a patient’s profile for deviations from the guidelines defined in a program
  • Wizard-driven task, goal, alert and program creation for flexible care plans consistent with up-to-date protocols
  • Multi-channel communication with the patient, primary care physician, and other members of the care team
  • Automated case management and control sends alerts, notifications, and correspondence to all involved parties
  • Next-step processing driven by business established guidelines
  • Right-time usage of program-specific business rules
  • HIPAA messaging support for straight-through transactional processing of authorizations
  • Seamless integration with external systems and content including claims, authorizations, membership, analytics, predictive modeling and clinical guidelines
  • Real-time dashboard reporting with ad-hoc report wizard
  • Robust audit trails
  • Pre-configured sample Diabetes program
  • Easy to use wizards that allow business personnel to:
    • create and maintain new programs, care plans, alerts, tasks, and goals
    • maintain alerts, tasks, and goals at the case level or the care plan level

Business Benefits

  • Reduce Costs – reduce inpatient stays and ER visits; eliminate unnecessary services
  • Increase Productivity – prevent human error, automate tasks, alerts, and correspondence; increase decisioning consistency and adherence to accepted protocols
  • Improve Outcomes – deliver right care to all members including those with co-morbidities
  • Foster Collaboration – by using a common, unified platform across channels and across the enterprise; coordinate care and communication with members, their support networks, care givers and providers
  • Achieve Competitive Agility - differentiate yourself for purchasers with BPM-powered care management for customized care and demonstrable savings

This article links to the following articles about the framework that are published as a group and can be read in sequence:





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