Care Management
Care Management
Enable proactive outreach with real-time clinical alerts
The Challenge
Case managers often lack a unified, up‑to‑the‑minute view of member data, forcing them to react to stale information instead of delivering proactive support:
- Delayed insights: Outdated claims and siloed feeds leave care teams reacting instead of preventing
- Manual triage: Care managers spend hours sorting through data to identify which members need intervention now
- Resource constraints: Limited staff capacity prevents consistent, timely outreach across your population
- Fragmented workflows: Disconnected systems hinder collaboration between care management and providers
The Opala Solution
Opala HealthSynq™ delivers unified, normalized clinical and claims data in near real time—so your team can focus on engaging members when they need help:
- Real-time hospital ADT & clinical alerts via FHIR, CCD, and HL7 messages
- Risk-driven prioritization using predictive analytics to spotlight high-risk members
- Embedded workflows that push alerts directly into your case management tools
- Scalable automation to handle spikes in admissions, discharges, and care-gap opportunities
- Seamless integration via API or direct feeds into your case management software, CRM, or BI platforms
- Rapid deployment: Go from contract to production in 4–6 weeks
Key Benefits
- Respond 60% faster to hospital admissions and discharges
- Reduce readmissions with timely interventions
- Boost care manager efficiency through automated triage
- Strengthen provider collaboration with shared, real-time member insights
How It Works
- Identify your population
We build dynamic rosters from your claims and membership data - Activate clinical feeds
Providers and other aggregators send ADTs, labs, and CDex messages for those rosters in real time - Normalize & prioritize
Opala HealthSync™ correlates clinical events with member information - Deliver actionable alerts
Notifications flow into your care management dashboard, BI tools, or CRM—ready for outreach
Customer Spotlight
“With Opala’s real-time ADT alerts feeding directly into our care management platform, our team cut intervention lag and drove a drop in 30-day readmissions—and lifting our MA Star ratings in parallel.”
– Leading Regional MA Plan