Care management and care coordination software
Digital Scientists builds custom care management and care coordination software: member records, care plans, task queues, outreach and reporting, fed by EHR, claims and eligibility data. For NeverAlone we built a care management platform that replaced Salesforce, and we still run it. For Congruity Health we turned claims and eligibility data into intervention tasks in the care team's CRM, tracking 7,020 patients. If a product on the market fits your model, we'll say so. Most projects start with a Blueprint: 4 to 6 weeks to agree scope, architecture and budget.
Updated
Patients on NeverAlone, which we run
Enrolled patients tracked for Congruity Health
Intervention triggers sent to Congruity's care team
Systems audited for CommuniCare Advantage
Should you build care management software or buy it?
Buy when your care model looks like the one the product was designed around. Build when your programs, data feeds or reporting don't fit it, or when care management is part of what you sell.
Packaged care management platforms do the standard job well: a member record, assessments, care plans, tasks and a caseload view. The trouble starts at the edges. A plan with its own eligibility feed, a provider running 24/7 virtual care, or a program serving people the vendor never designed for ends up with workarounds in spreadsheets and a second system nobody trusts.
Most of our clients land in the middle. They keep the EHR or CRM they have and build the care workflows on top of it, or they replace the CRM once it starts dictating the work. A Blueprint tells you which option fits, and sometimes the answer is to buy. See healthcare product development.
Four ways to get care management software
| Option | When it fits | What you give up |
|---|---|---|
| Buy a care management platform | Standard programs, standard assessments and reporting the vendor already supports | Control of workflows, data model and roadmap |
| Configure your CRM | Outreach and task queues matter most, and the CRM is already in place | Clinical depth; the CRM shapes the workflow |
| Build on top of what you run | The EHR or CRM stays, and care teams need their own queues, triggers and reports | More to own: integration upkeep and hosting |
| Build a custom platform | Care management is the product, or no vendor fits your model, as on NeverAlone | The most to own. It needs a team to run it, ours or yours |
You own the code and the IP for anything we build. See CRM integration.
What goes into care management and care coordination software?
Six pieces: the member, the care plan, the task queue, outreach, eligibility and reporting. Care coordination is the same work shared across teams and organizations, so every piece needs clear ownership and an audit trail.
Member record
One view of the person: demographics, conditions, recent visits, risk level and who on the team owns them.
Care plans
Goals, interventions and assessments such as an HRA, tied to the person and updated by the interdisciplinary care team.
Task queues
Work that arrives on its own: a claims trigger, a missed visit or a discharge creates a task with the reason attached.
Outreach
Calls, video, SMS and email from the member record, with every attempt and outcome logged.
Eligibility and enrollment
Plan files loaded on a schedule, with members added, changed and termed without manual entry.
Reporting
Caseloads, completion rates and the audit reports your plan, state or CMS asks for. See quality measures.
Where does the data in care management software come from?
From the systems you already run: the EHR, claims, eligibility files, the CRM and the phone and video tools. If it has an API, a standard interface or a reliable export, we can integrate with it.
On NeverAlone we bring in PointClickCare and Netsmart (GEHRIMED) data and match patients across EHRs, so a care partner sees one person and not two records. Video runs on AWS Chime, which we run in production.
For Congruity Health the data came from claims and eligibility files. The platform analyzed them for musculoskeletal and Type II diabetes events, flagged the members who needed outreach, and delivered each trigger as a task in the care team's CRM with the reason and visit history attached. That's the screen in the image at the top of this page. See healthcare data engineering.
EHRs
PointClickCare, Netsmart (GEHRIMED)
Claims
Medical and pharmacy claims files
Eligibility
Plan and TPA enrollment files
CRM
Salesforce or a custom platform
Video and phone
AWS Chime, Twilio, Bandwidth
Analytics
BigQuery, SQL data marts, Power BI
What care management work has Digital Scientists delivered?
A care management platform we built and still run, a claims-to-intervention pipeline for a care team, Special Needs Plan reporting for a Medicare Advantage plan, and a partnerships platform for a health system.
NeverAlone (production). In January 2022 we replaced Salesforce with a care management platform we built, bringing care coordination and provider management in-house. NeverAlone now serves 30,000 patients across six states, and we run it 24/7.
Congruity Health (delivered). Claims and eligibility data turned into intervention tasks in the care team's CRM: 7,020 enrolled patients tracked and 968 intervention triggers.
CommuniCare (delivered). We mapped care management workflows to the NCQA SNP Model of Care and extracted HEDIS MY2023 supplemental data against NCQA specifications. For CommuniCare Advantage we built a data mart with HRA, ICT and ICP completion reports and the Universe Report for CMS audits.
Duke Health (delivered). A research platform and custom CRM that brings Duke's community partnerships and SDOH data together. See the SDOH research platform.
Patients on NeverAlone across six states
Enrolled patients tracked for Congruity Health
Intervention triggers delivered to the care team
Year our platform replaced Salesforce on NeverAlone
Care management work we've delivered
NeverAlone · CommuniCare
Salesforce replaced with a platform we run
A custom care management platform for the care team behind a 24/7 virtual care service that began as a 90-day MVP and now serves 30,000 patients.
See the work
Congruity Health
7,020 enrolled patients tracked
Claims and eligibility data analyzed for intervention triggers, delivered as tasks with patient context in the care team's CRM.
See the work
CommuniCare Advantage
60+ systems audited, 25% smaller footprint
A data mart and reporting suite for a Medicare Advantage plan, including HRA and ICT/ICP completion and the Universe Report for CMS audits.
See the workTrusted by healthcare leaders.
“The team at Digital Scientists was a huge help in not only developing our analytics platform, but understanding the competitive space and defining our true value proposition for our customers.”
Justin Davis
CEO, Congruity Health
“I would highly recommend Digital Scientists. Their ability to work seamlessly with us, understand our needs, and deliver solutions that drive our mission forward is exceptional. They have not just been a service provider, but a partner in our journey towards improving care for special needs individuals and vulnerable populations.”
Robert Hager
CEO, CommuniCare Advantage
Related services
CRM integration
Connect clinical and claims data to the CRM your care team uses.
CRM integration →Quality measures
HEDIS, Star ratings and the data behind them.
Quality measures →Health plans and payers
Software and data work for health plans.
Health plans and payers →Healthcare CRM
Custom CRMs for patient and member relationships.
Healthcare CRM →Data engineering and analytics
Pipelines, data marts and dashboards for care and claims data.
Data engineering and analytics →
Common questions about care management software
Build or buy care management software?
Buy when your programs, assessments and reporting match what the product was designed for. Build when they don't, when you need data feeds the vendor won't take, or when care management is part of what you sell. Many organizations keep their EHR or CRM and build the care team's queues and reports on top of it. A Blueprint, 4 to 6 weeks, gives you the answer with the costs on both sides.
Can it take eligibility files from our plan?
Yes. For Congruity Health the platform took in claims and eligibility data on a schedule and turned it into outreach tasks. We load plan and TPA enrollment files, including X12 834 or flat files, add, change and term members automatically, and flag records that don't match. See claims and X12.
Does it support SNP Model of Care reporting?
We build it to. For CommuniCare we mapped care management workflows to the NCQA SNP Model of Care and extracted HEDIS MY2023 supplemental data against NCQA specifications. For CommuniCare Advantage we built HRA completion, ICT and ICP completion and Universe Report reporting for CMS audits.
Can care managers call members from it?
Yes, when calling is in scope. Video runs on AWS Chime, which we run in production on NeverAlone. Phone dialing from the platform is something we build and scope with your contact center team, and every attempt and outcome is logged on the member record. See contact center and telephony.
Is care management software HIPAA compliant?
We build it to be. We sign a BAA before we touch patient data, encrypt PHI at rest and in transit, and build role-based access and audit logging in from the first week. Our security plan is mapped to NIST CSF 2.0, and each client gets a security addendum. See security and PHI.
Talk it over
Tell us what you are trying to do. A senior person from our Atlanta team replies within one business day, and you can book a 30-minute call right after you send this.
- We tell you if we're the right fit, and if we're not, who is.
- Most work starts small, so you see how we work before you commit to more.
- We sign a BAA before we touch patient data.