For care management & VBC
Longitudinal care. Measurable outcomes.
Longitudinal timelines, Care Graph-grounded cohort analysis, AI-sequenced outreach, and outcome evidence your value-based contracts actually need — with a Benchmark Network to compare beyond your own walls.
Care management pains today
High-touch. Underpowered. Hard to prove.
High coordination burden
Care managers spend hours a day stitching together data, tasks, and messages across systems nobody agreed on.
Manual risk stratification
Cohort risk built by hand in spreadsheets, refreshed weekly, and out of date by the time anyone acts on it.
Outreach at scale
Scripted outreach sequences that do not adapt, on channels patients did not choose, with response rates nobody measures.
ROI reporting
Value-based contracts demand outcome evidence, but the operating stack cannot produce it on the cadence payers expect.
Leakage you cannot see
Missed contacts, dropped follow-ups, abandoned enrolments and stalled approvals disappear into the gaps between systems — and cannot be recovered.
No real comparability
You cannot compare pathways across sites or against peer services because definitions, events and rules drift between branches and vendors.
What careos delivers
Structured, continuous, and comparable.
Longitudinal patient timeline
Every event, every contact, every observation on a single timeline — across episodes, settings, and years.
Care Graph-grounded cohorts
Cohort queries run against the structured Care Graph — not a denormalised dashboard — with live updates.
AI outreach sequencing
AI-assembled outreach sequences with channel, timing, and content adapted per patient, staged for human approval.
Outcome tracking
Pathway adherence, observation deltas, medication adherence, and cohort-level outcome evidence, continuously.
Benchmark Network
Opt-in, de-identified cross-tenant benchmarks so pathway and outreach performance can be compared beyond your own walls.
Leakage prediction
Surface revenue and outcome leakage two steps ahead — missed contacts, stalled approvals, abandoned enrolments — from the connected event stream.
Risk stratification
Transparent. Explainable. Live.
Structured observations
Vital signs, PROMs, self-reports, and clinical observations captured as typed events with provenance.
Threshold rules
Configurable thresholds per cohort and per patient, with alert routing to the correct owner.
Composite risk logic
Multi-factor risk scores built from observations, pathway state, and history — transparent, explainable, auditable.
Alert routing
Alerts routed with context to the right care manager, with escalation paths when nothing is acknowledged.
Deterioration rules
Multi-observation deterioration rules over configurable time windows, surfaced as structured alerts with trend context.
Social & behavioural factors
Versionable, country-pack-aware social and behavioural data classes feed risk logic alongside clinical signals.
Value-based care metrics
The numbers your payers actually ask for.
Pathway adherence
Percentage of patients at each pathway step, time in step, and drop-off points.
Medication adherence
Refill gaps, missed doses, and adherence deltas over time by cohort.
Outcome deltas
Observation trends, PROM scores, and outcome signals tracked against baseline.
Cohort benchmarks
Your cohorts compared against opt-in de-identified cross-tenant benchmarks.
Engagement metrics
Channel performance, response rates, digital adoption and communication cost per cohort — measured, not guessed.
AI worker impact
Per-agent time saved, approval and override rates, and outcome deltas — the numbers value-based renewals actually depend on.
AI workers for care management
Scoped agents. Human approval.
Care Coordination Agent
Watches pathway progress across cohorts. Surfaces patients falling behind. Drafts follow-up for human review.
Medication Adherence Agent
Watches refill and administration patterns. Flags drift. Drafts targeted outreach for pharmacist approval.
Inbox Triage Agent
Classifies inbound patient messages. Routes to the correct queue. Drafts initial responses for care manager approval.
Benchmark Network
Compare beyond your own walls.
Opt-in
Participation is opt-in per tenant. You decide what your service contributes and what you see in return.
De-identified
All contributed data is de-identified and aggregated. No patient-level data ever leaves your tenant boundary.
Cross-tenant insights
See how your cohorts and pathways compare to peer services running similar populations.
For care management & VBC
Prove the outcome. Not the activity.
Bring a cohort, a contract, and the numbers that matter. We will show you the evidence you could generate with careos in place.