The GuidingCare® Business Rules Engine is an advanced solution designed to address the dynamic needs of today's healthcare industry. Health plans must rapidly adapt to regulatory changes, competitive pressures, and large-scale events, particularly within care management functions such as care coordination, utilization management, population health, and more.

Key Benefits

Leveraging the Business Rules Engine, GuidingCare streamlines operations by automating business processes and workflows. This enables health plans to efficiently manage complex member care. Key benefits include:

• Streamlined Workflows: Apply consistent business rules to enhance efficiency and automate activities related to complex care coordination.
• Integration with Predictive Analytics: Incorporate predictive modeling, risk identification, scoring, and stratification into operational rules.
• Configurable Based on Needs: Modify rules easily to meet changing business requirements, including eligibility routing and authorization approvals.
• Identification of Gaps in Care: Identify and address gaps in care based on clinical data and member events, enabling targeted interventions.

GuidingCare Rules Designer

The GuidingCare Rules Designer provides further control by allowing health plans to create, manage, and deploy business rules independently. This tool includes:

• User-Friendly Interface: Simplify rule creation with a drag-and-drop interface, pre-built templates, and decision modeling capabilities.
• Built-in Testing: Manage rule versions and test multiple rules with comparison queries; verification queries detect logical issues.
• Decision Modeling: Visualize and diagram decision relationships for easier rule development.
• Flexible Deployment: Control rule deployment across various environments for thorough testing and validation. Ultimately, the GuidingCare Business Rules Engine empowers health plans to effectively manage complex care in real-time, driving value-based care and improving outcomes with advanced automation and predictive analytics.