Program configuration with currencies, partners, badges, widgets, processes, and partner ledger management.
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Member lifecycle tracking with currency balances, tier status, ledger traceability, and membership transitions.
Game mechanics with definitions, participant tracking, and reward distribution to drive member engagement.
High-volume batch job definitions, execution tracking, partitioning, and failed record handling for loyalty operations.
Knowing who you are treating and what they deserve. Powers benefit verification requests, digital identity checks, custody chain tracking, and the procedural definitions that ensure compliance.
Healthcare transparency in action. Processes service information requests, response actions, coverage details, suggestions, and the resource URLs that help patients and providers make informed decisions.
Getting the right care at the right time. Coordinates schedule broadcasts, appointment resources, service territories, work types, work procedures, and the capacity management that keeps care delivery running.
Building the care delivery ecosystem. Tracks healthcare providers, facilities, practitioner affiliations, specialties, taxonomies, NPI data, accreditations, and network contract relationships.
The foundation beneath the clinical surface. Assessment configurations, action plan templates, booking configs, record actions, and the system-level objects that make Health Cloud workflows possible.
Pharmaceutical care, reconciled. Handles medication reconciliation, therapy reviews, statement-level analysis, and the recommendations that help clinicians optimize drug regimens and catch interactions.
Breaking down silos between systems. Manages interop topics, subscriptions, trigger criteria, notification resources, and the filters that enable seamless health data exchange across platforms.
Quantifying wellness and risk. Calculates health scores, risk adjustment factors, hierarchical condition categories, indicator results, and the performance periods that track population health trends.
Keeping patients connected and informed. Tracks engagement interactions, attendees, topics, tracked communications, and the outcome activities that measure the impact of outreach efforts.
What is covered, for whom, and how much. Defines coverage benefits, member plans, plan benefit items, purchaser plans, and the limits that shape what patients can access under their health plans.
Where medicine meets data. Captures diagnoses, procedures, clinical encounters, observations, measures, preauthorizations, and the clinical decision support that powers evidence-based care.
The gatekeepers of appropriate care. Manages utilization review requests, drug authorizations, reviewer assignments, exchange information, and the supporting content that drives authorization decisions.
The orchestration layer for population health. Manages care programs, enrollee journeys, eligibility rules, team members, and the products and providers that support coordinated care initiatives.
Personalized healing, structured. Tracks care plans, activities, goals, templates, episodes, barriers, determinants, and the detailed clinical context that drives individualized patient care.
The financial language of healthcare. Models fee schedules, bundled care agreements, capitation arrangements, shared savings, and the contract payment structures that determine provider reimbursement.
Risk meets rules. Powers underwriting evaluations, rule definitions, stage transitions, deviations, and the integration providers that feed automated decisioning engines.