“Your rapid deployments and robust capabilities—I’ve never seen anything like it.”
— Director of Operations,
When care teams are working in silos, referrals fall through the cracks, and compliance risks grow, progress stalls fast.
That’s the position one big health plan found itself in—until they partnered on a rapid deployment that changed how their teams work, communicate, and engage members. Within weeks, they had a fully operational care navigation system driving measurable impact across CM, UM, and quality.
In this behind-the-scenes look, we break down how this plan moved from reactive processes to proactive care coordination—and what made it possible.
The Challenge
- Care teams and departments working in disconnected systems
- Referral tracking buried in email threads
- Delayed follow-up after hospital discharges
- Limited visibility into member activity and risk
- Compliance concerns around PHI sharing
- Pressure to close care gaps and meet regulatory timelines
The ask: deliver something that works—fast, secure, and tailored to their environment.
The Solution: Rapidly Deployed, Purpose-Built
Rather than layering another generic platform on top of existing problems, the team collaborated on a fully tailored solution that addressed their most urgent gaps from the ground up. What followed was a deployment timeline the plan’s leadership said they had “never seen before”—with core functionality rolled out and live in a matter of weeks.
What’s Now Live in Their CareNavigator Platform
🔹 Care Gap Management
- Prospective gaps loaded monthly
- Teams attest directly in the member profile
- Verified through claims data monthly
🔹 Medication + Referral Tracking
- Medications are visible in real-time
- Referrals are no longer email-based—they’re automated and traceable
🔹 High-Risk Member Alerts
- Frequent ED visits or high-risk flags auto-trigger escalations
- Outreach teams send to CM with a single click
🔹 Appointment & Problem List History
- Pulled primarily from claims, editable when needed
- Gives a complete picture to CM, UM, and providers
🔹 ADT Integration + Post-Acute Care Journeys
- Daily PAR files drive real-time engagement after hospital events
- Supports 7-day post-acute HEDIS measures
- Members automatically enrolled in the right follow-up journeys
🔹 Risk Scoring Engine
- Combines clinical, behavioral health, SDOH, and utilization data
- Risk profiles presented to CM, UM, and providers for prioritized outreach
🔹 Custom Dashboards
- Care Team View: Highlights high-need members and actions
- Manager View: Tracks performance, flags areas needing attention
🔹 Secure Messaging
- HITRUST-certified communication replaces unsecured email
- Improves accountability and protects PHI across organizations
🔹 Provider Quality Dashboard
- Built in two weeks to meet Exchange and regulatory timelines
- Tracks access and performance, sourced from a secret shopper initiative
The Outcome
The platform allowed the health plan to stabilize fast—and scale even faster. With improved visibility, team coordination, and secure workflows, they turned urgent needs into operational strengths.
“The abilities we now have at the plan to support a rapid turnaround in CM, UM, Quality and timely engagement for ALL members… The improved secure information sharing and accountability for all members is key to our success.”
What started as a crisis-response build became a long-term solution.
Want to See What This Could Look Like for Your Plan?
We build custom care navigation systems that meet the demands of today’s payers—with speed, security, and smart design at the core.
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