From raw data to retained members — in four steps.
Carelytics connects to your existing systems, identifies members at risk, triggers targeted interventions, and tracks every outcome — automatically.
Connect your plan's data
Carelytics ingests claims, pharmacy, enrollment, and SDOH data from your existing systems. No rip-and-replace. Standard HL7 and flat-file feeds have you live in weeks, not months.
AI scores every member for risk
Our ensemble AI model — trained on 150+ clinical, behavioral, and social features — flags members at risk of disenrollment, medication non-adherence, or HEDIS gap creation 60–90 days before they become a problem.
Automated, personalized outreach
The Intervention Engine routes the right action to the right channel — electronic refill requests via Surescripts, SMS reminders, care manager alerts, or live agent escalation — based on each member's risk profile.
Track outcomes & HEDIS performance
Real-time dashboards show open HEDIS gaps by measure, member, and provider. Track medication adherence rates, intervention ROI, and projected Star Rating impact — all in one place, updated continuously.
See Carelytics in action
Get a personalized demo tailored to your plan's quality and retention challenges.