Turn Care Coordination Into Documented, Billable Work
MemberCare gives ACOs, CINs, and VBC organizations the operational infrastructure to capture all four CMS care management programs, close care gaps, and demonstrate quality outcomes to payers.
The Barriers to Value-Based Care Success
Volume-to-Value Transition
Shifting from fee-for-service requires entirely new workflows, metrics, and revenue streams. Most organizations lack the technology infrastructure to make the transition.
Quality Metrics Pressure
Payer contracts depend on quality metrics that require proactive patient outreach and care gap closure. Reactive care models can't meet these benchmarks.
Poor Patient Engagement
Between visits, patient engagement drops. Without digital tools to maintain the connection, avoidable hospitalizations and ER visits erode shared savings.
Overwhelmed Care Managers
Care coordinators drown in manual documentation, phone tag, and fragmented tools. The administrative burden prevents them from doing high-value clinical work.
The Operational Engine for Value-Based Care
From care gap identification to quality reporting, MemberCare automates the entire value-based care workflow -- with AI that makes every care manager more effective.
All 4 CMS Billing Programs
CCM, RPM, PCM, and RTM with automated time tracking, CPT documentation, and monthly billing summaries for your billing team.
Care Gap Identification
Automatically surface overdue screenings, missed follow-ups, and preventive care gaps across your population. Track closure rates for quality reporting.
AI-Assisted Care Plans
Care Plan Designer AI drafts measurable care plans with goals, activities, barriers, and participants -- for clinician review and approval. Plans align to quality metrics and payer requirements.
Population Health Management
Stratify patient populations by risk level, condition, and engagement. Target outreach to high-risk patients who need it most.
Quality Metric Tracking
Real-time dashboards track quality measures across your patient population. Identify performance gaps early so you can course-correct before reporting deadlines.
Distress Screening
NCCN Distress Thermometer and structured assessment tools identify patients who need additional support -- supporting HEDIS and CMS quality requirements.
Care Work, Documented as It Happens
Eligible care work is timed, attributed and documented as it occurs -- helping your billing team capture work that might otherwise go unrecorded.
Built for Every Value-Based Care Model
ACOs
Accountable Care Organizations need population management, care gap closure, and quality reporting to earn shared savings.
CINs
Clinically Integrated Networks need standardized protocols and unified analytics across independent practice members.
Medicare Advantage
MA plans need star rating improvement, chronic condition management, and reduced total cost of care across their member population.
Medicaid Managed Care
Medicaid MCOs need patient engagement tools, care coordination, and quality metrics for complex, high-need populations.
Ready to Operationalize Value-Based Care?
See how documented care management, AI-drafted care plans, and care gap closure can support your VBC quality goals and billing workflow.
Or call us: 214.226.5319