From signal
to closed gap
in one system.
Carelytics watches every member in your plan continuously — detecting care gaps, writing the right message, submitting the refill, arranging the ride, and closing the loop. All without anyone manually starting it.
Every intervention
follows the same path.
Whether it's a missed refill, an overdue lab test, or an unused benefit — Carelytics runs the same intelligent pipeline from detection to closed loop.
Most plans detect gaps after claims arrive. Carelytics intervenes upstream — in the clinical window where outcomes can still change. It's the difference between reacting to cost and preventing it.
Two engines. One system.
Zero gaps between them.
Carelytics is built around two deeply integrated platforms. The intelligence layer that surfaces what needs to happen — and the engagement layer that makes it happen.
The intelligence that tells your team what to do next
A real-time risk and quality platform that gives care managers, quality directors, and clinical teams an AI-powered view of every member — with priorities, gaps, and recommended actions already ranked.
The system that reaches members and gets things done
An AI outreach engine that communicates with members across every channel — completing care actions automatically, escalating when human judgment is needed, and never leaving a non-digital member behind.
What actually happens
when a signal fires.
Here's a real example — Maverick, a 67-year-old Medicare Advantage member — walking through every step of what Carelytics does in the background.
102-field record, updated in real time
Four signals, one intervention event
Navigator: DeAndre
Real systems, no humans
Gap closed in real time
Acts before the claim arrives.
Traditional plans analyze data after claims land — which is too late to change outcomes. Carelytics monitors lab results, HIE alerts, and Part D / PDE data continuously, surfacing conditions before the plan ever sees a claim. That's the clinical window where interventions actually work.
Test clinical logic with zero risk before it reaches members.
Before any care manager runs a new campaign or protocol, Carelytics lets them simulate it against live member profiles in a sandboxed environment. See the projected HEDIS impact, which members would be reached, and what actions would fire — all before a single real message is sent.
Reaches every member,
on their terms.
Not every member uses a smartphone. Carelytics never forces digital engagement — it reaches members through whatever channel actually works for them.
Built for every team
that touches member health.
Carelytics isn't a point solution. Every department at your health plan gets a capability that makes their core work measurably better.
Connects to everything
your plan already has.
No rip-and-replace. Carelytics connects to your existing data infrastructure through standard formats.
See Carelytics work
on your actual members.
We'll run a live demo using your plan's measure set and show you exactly how many gaps Carelytics would close in the first 90 days — with a projected Star Rating impact report.