Population health management solutions
Empower your healthcare teams with data-driven clinical insights and seamless collaboration on a unified managed care and population health management platform.
Transform your Approach to Managed Care with ACUITYnxt™
KEY FEATURES
POPULATION HEALTH ANALYTICS
Leverage Johns Hopkins ACG® Predictive Analytics and near real-time reporting to identify high-risk members, close gaps in care, and proactively manage chronic conditions. Gain actionable insights through dashboards and analytics that help optimize resource allocation, improve care coordination, and support better member outcomes.
UTILIZATION MANAGEMENT
Streamline Utilization Management with configurable workflows, automated authorization routing, integrated clinical guidelines, and complete audit trails. Accelerate decision-making, improve regulatory compliance, and provide full visibility into authorization activities while reducing administrative burden.
CASE AND CARE MANAGEMENT
Improve care coordination with configurable Care Management workflows, assessments, individualized care plans, task management, and member engagement tools. Automate routine processes, standardize clinical workflows, and empower care teams to focus on delivering personalized, member-centered care.
APPEALS AND GRIEVANCES
Simplify the management of appeals and grievances with automated workflows, configurable business rules, task routing, and regulatory tracking. Manage cases, authorizations, provider disputes, and claims efficiently while supporting CMS, NCQA, and URAC compliance requirements.
CLINICAL PROGRAM SUPPORT
Support disease management, maternal health, behavioral health, transition of care, and other specialty clinical programs with configurable assessments, care plans, and workflow automation. Deliver personalized interventions while improving quality outcomes and operational efficiency.
QUALITY AND RISK MANAGEMENT
Identify high-risk populations using predictive analytics, risk stratification, and configurable business rules. Prioritize members for care management, monitor quality initiatives, improve HEDIS performance, and support value-based care programs with actionable clinical insights.
Easy to Use. Built to Scale.
ACUITYnxt™ is a configurable, cloud-based managed care platform that grows with your organization. Built for health plans, TPAs, ACOs, and other risk-bearing organizations, its intuitive, modular architecture enables you to implement the capabilities you need today; including Care Management, Utilization Management, Prior Authorization, Appeals & Grievances, Population Health Management, and Member & Provider Portals, while seamlessly expanding as business needs evolve.
Improve collaboration through secure member and provider communications, integrated correspondence, configurable notifications, document management, and self-service capabilities. By connecting clinical, operational, and administrative workflows in a single platform, ACUITYnxt helps organizations improve care coordination, increase productivity, reduce administrative burden, and deliver better member outcomes.
ACUITYnxt Ecosystem
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VISUALIZATION
Intuitive user interface
Personalized user views
Team based work queues
Ad hoc data filtering and exports
Comprehensive library of reports and dashboards
Interactive charts, graphs, and data visualization
Drill-down capabilities from summary to detailed records
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SYSTEM ADMINISTRATION
Intuitive Drag and Drop Configuration
Reusable and archivable screen templates
Multi-record editing for efficient updates
Robust role-based security
Embedded Administration Guide with detailed documentation
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AUTOMATION
Powerful business rules engine to prioritize work
Intelligent workflow automation for consistent processes
Automatic event and/or time-based escalations
Configurable task or next action routing and work assignment (Round Robin)
Trigger-based workflows across the modules
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EASE OF USE
Clinician designed, intuitive user experience
Flexible workflows that adapt to your organization
Minimal training required with intuitive navigation (“Look for an orange button”)
Personalized user preferences and saved settings
Embedded End User Guide with searchable help content
Consistent navigation across all modules
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BUSINESS OUTCOMES
Reduce administrative burden and manual processes
Improve member health outcomes and quality of care
Increase care manager productivity
Streamline Utilization Management workflows
Strengthen audit readiness
Support CMS, NCQA, and URAC compliance
Consolidate multiple point solutions into one platform
