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Care Quality

Personalized, data-driven, and actionable care plans at your fingertips.

A male doctor in a white coat with black glasses and a beard smiles and reaches out to high-five a young patient in a mustard sweater holding a teddy bear while the child's mother smiles behind him.

Balancing quality care and affordability with empathy and efficiency.

Care Quality ensures strategies and services are in place to improve care and reduce costs for members with the highest degree of need. Our advanced care management ecosystem reduces inefficiencies and empowers you to focus on caring for those who need it most.

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Care Management

Case Study: Cascade Health Alliance

Integrated Care

Blog: Care Management

Care Optimization

White Paper: 11 Strategies for Leaders

Care Management

Our interoperable Care Management platform is built on a foundation of automation, standardization, and mature processes, utilizing data from proven, industry-standard COTS products such as the Johns Hopkins ACG System and administrative and clinical information.

Utilization Management

Utilization Management addresses the most pressing needs of state Medicaid programs by combining cost management with accurate pre- and post-payment claim reviews and prior authorization from our Clinical Care Reviews.

Additional solutions making healthcare more efficient and effective.

Coordination of Benefits

Providing comprehensive and innovative third-party liability solutions.

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Data & Analytics

Transforming your most complex data into actionable insights with Gainwell Genius™.

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Payment Integrity

Helping plans avoid and recover improper payments while detecting and preventing fraud.

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Actionable insights that
empower healthcare progress.

We’re passionate about delivering ideas that can help shape the future of
healthcare, using education and transparency to improve health outcomes for all.

Five Considerations for Evaluating Next-Generation Care Management Solutions

Five Considerations for Evaluating Next-Generation Care Management Solutions

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How can we support you?

Coordinate support for the most vulnerable Medicaid members to improve their health while lowering the total cost of care.

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Is Your State Ready for What CMS Expects Next With AI?

Federal mandates are accelerating. Interoperability deadlines are here. AI is no longer optional — it's an operational imperative. This 3-minute diagnostic reveals where your Medicaid program stands across the five dimensions that matter most.

15 questions · 5 categories · Takes ~3 minutes