Advalent Care Manager: Payer Based Care Management System
Technology driven high-quality, affordable healthcare to optimize your investments

Advalent’s technology driven Care Management solution supports a wide range of programs, like case & disease management, utilization management, care coordination, risk assessment & stratification, HRA, wellness and health coaching. We offer end-to-end service platform to seamlessly address the healthcare needs across the continuum of care, with the target of achieving improved care experience and patient satisfaction, quality of care, while ensuring appropriate and timely utilization of necessary services. Our solution includes NCQA HEDIS® measures suite, Medicare five-star quality measures and ensures that the Medical Loss Ratio (MLR) standards are met to promote quality improvement activities, leading to improved outcomes, lowering medical errors, and preventing high cost events like readmission and ER visits. The solution provides all the programs and features required for clinicians to participate in the Merit-based Incentive Payment System (MIPS), and to meet all the MACRA quality payment program standards.


Data-driven Care Management Work-flow

With NCQA certified HEDIS® measures and a suite of evidence-based care rules, and Miiliman MARA risk scores, we process medical, pharmacy and data from other sources to integrate all the value-based analytics into your daily work-flow. Our data driven care plans with automated scheduling, alerts and automated messaging and notifications are used to optimize the care delivery, and help in transition of care.


Population health to Care management

Advalent’s Risk Stratification module uses prospective and concurrent risk scores, clinical events, and a range of member-specific attributes to identify the cohorts of individuals for targeted clinical intervention. The system generates personalized care plan for these based on claims and other clinical data. We provide data-driven actionable items that are personalized and readily available to care team members during member outreach.


Data extracts for Clinical analytics

Patient clinical information, compliance status to care rules and standards of care, outreach outcome and all care team members’ and patient’s activities can be easily extracted for further clinical analytics, and for documentation purposes. We track the PMPM, utilization metrics and other clinical and financial information and make them readily available in the form of reports and dashboards that can be customized to your exact needs.


  1. Advalent Care Manager can connect to multiple systems and help achieve operational efficiency. This eliminates the need to switch between systems and in turn removes redundancy, saving time and money maintaining multiple systems
  2. Easy Configuration/ Low cost – As a cloud based solution it has zero technology foot print and maintenance is bundled into product
  3. Advalent Care Manager is future proof – Advalent platform evolves to meet new regulations (including MIPS/MACRA) and new technologies
  4. Provides centralized view of medical management operations – population management, care management and utilization management


  1. Highly configurable and wide feature range – One tool to support multiple needs
  2. Data capture from multiple sources – System understands different formats
  3. Single sign-on platform for population, care management and utilization management – NCQA HEDIS® certification, Milliman MARA and MCG CareWebQI Integration
  4. Data-driven value-based analytics with evidence based guidelines, and system driven care plans that care customizable
  5. Increase Quality of Care, NCQA HEDIS® scores, and improve your star performance
  6. Increased efficiency and productivity – High ROI


  1. Lower re-admission rate, lower ambulatory care sensitive admissions and ER Visits, and decreased length of stay
  2. Improved referral management process – Improve identification of services that require referral and remove referrals that are not generating enough ROI
  3. Identify care opportunities to improve the overall health of the population and help meet national quality guidelines
  4. Encourage patients to implement positive lifestyle behaviors that positively impact health and related costs
  5. Streamlines scheduling, messaging and outreach efforts
  6. Proactive care management, patient engagement, care gap prompting and closure, shared decision making and system driven clinical insights to enable practice oversight.