Empowering Health at Home

John Driscoll

Problem Tech Solves

The home is the most convenient and cost-effective healthcare setting, and it is also the most under-utilized, especially after a hospital stay. Many times, individuals either leave the hospital without proper support systems in place or end up in sub-acute facilities such as nursing homes for no other reason than that is the typical course of action. This improper management of care transitions limits access to the right care and increases costs and waste, while potentially raising the likelihood of an unnecessary readmission. A paradigm shift must occur for the US healthcare system to migrate to true value-based care. We must bring care to people, when and where they need it: at home. Through intelligent insights, CareCentrix leverages deep-learning, trained on a quarter-billion medical records to predict each individual’s best path of care to live, heal, and age at home. Clinical teams and care navigators use the insights and predictions created by CareCentrix models to more accurately assess an individual’s optimal site of care, preventing expensive return trips to the hospital and unnecessary facility-based care.

Tech Brief

The CareCentrix model leverages predictive analytics to enable whole-person care, accounting for both a patient’s clinical and non-clinical needs. The model is based on three key pillars – addressing social needs, making care personal, and powering it with technology. CareCentrix’s “whole-person diagnostics” enable these pillars, allowing for the assessment not only of a patient’s medical condition but social factors as well, such as if they have access to nutritional foods and adequate transportation. Care is personalized through digital nurse coaching, which helps patients work toward goals specific to their circumstances. All of this is powered by CareCentrix’s comprehensive analytics database, which contains 10 billion claims and 250 million patient discharges, as well as more than 500 data points on individuals receiving care in the home for millions of home visits annually. Notably, CareCentrix also analyzes more than 100 SDoH data elements covering more than 99 percent of Americans, which, when combined with the other predictive metrics, presents a complete view of the individual to better assess and address their individual needs. When the patient is in the home, CareCentrix utilizes advanced telehealth and remote patient monitoring tools to track a patient’s condition in real-time, enable earlier clinical interventions focused on the home as the primary site of care, and continually communicate with the individual, caregiver, provider, and health plan manager about the individual’s condition.

Tech Differentiators

Using limited data causes gaps between what care members actually need and what they receive. CareCentrix’s proprietary predictive analytics tool closes those gaps, which removes inefficiencies and drives down cost. While other platforms only use broad ZIP code and community-level data, CareCentrix analyzes individualized determinants and health data per each unique member. This unique approach is how they ensure members receive the right care at the right time; improve and positively impact costs, and ensure quality, whole-person care for members. In addition to these predictive analytics, CareCentrix also utilizes various other tools that differentiate the company from its competitors. Through digital engagement and remote monitoring, electronic visit verification, dedicated support to case managers, efficient network management, care plan optimization, utilization and benefits management, chronic and palliative care management, post-acute transitions management, and payment integrity and FWA tools, individuals whose care is overseen by CareCentrix have better outcomes, an improved member experience, and lower costs. Other companies in this space do not integrate all of those tools into their platform and therefore do not deliver as successful results to their customers. The CareCentrix platform ingests and bridges streams of data from providers and payers, two parties who too often have disparate incentives. To deliver optimal insights, CareCentrix collects and leverages claims data from payers, pharmacy claims, and providers’ electronic medical records, ensuring that recommendations are not built in a silo. This ability to ingest and analyze data sets, no matter the source, distinguishes CareCentrix in the home care space.


In March, independent healthcare research and consulting firm Avalere released an analysis of the CareCentrix model and found CareCentrix lowered the total cost of care, improved outcomes, and reduced hospital readmissions and emergency department visits. The analysis compared a Medicare Advantage population managed by CareCentrix to a statistically similar cohort not managed by CareCentrix and found the following: • A 44 percent lower total cost of care in the CareCentrix cohort during the initial 90 days after discharge. • A 27 percent lower total cost of care 12 months after discharge, demonstrating the longer-term positive effects of the CareCentrix model. CareCentrix is able to achieve these savings by prioritizing whole-person care, directing more care to the home, and providing the care and resources necessary to keep people there. Among the CareCentrix-managed cohort: • Hospital readmission rates were up to 22 percent lower during the initial 30, 60, and 90 days after discharge. • ED visits were reduced by 21 percent compared to the baseline metric for this cohort, compared to only a 10 percent reduction in ED visits for the non-CareCentrix cohort. • Skilled nursing facility expenditures following hospital discharge were reduced by 71 percent, compared to a 47 percent reduction in the non-CareCentrix group. • Costs across major disease categories evaluated were all lower than the non-CareCentrix managed cohort: musculoskeletal (47%), digestive (21%), respiratory (21%), circulatory (17%) and nervous (12%). By leveraging predictive analytics and providing a comprehensive set of tools that help manage the entire patient journey, CareCentrix achieves significant cost reductions.

Why Us

CareCentrix leverages the best in data science with unparalleled clinical acumen to deliver verified cost savings and improve outcomes, all while directing more care to where the individual wants to be: at home.

❮ Return to FULL LIST OF FINALISTSView Next Company❯