Workflow cloud 02 · Care Operations
Your care manager opens one worklist. Every program is there.
For care management, coding and quality teams.
Kairon Health runs transitions of care, care management, HCC coding and quality gap closure on one engine. Discharges arrive from hospital ADT feeds, and gap worklists refresh nightly.
The demo runs Care Graph on illustrative data, and works best on a larger screen.
Measured in production
- ↓70%Less nurse wrap-up time after every callMedian 14 → 4 min.
- +64%Patient calls per nurse181 → 296 a month.
- 2×Faster from discharge to the nurse worklist40h → 19h.
- ↓35%Faster first contact after discharge76h → 48h.
- ↓45%Fewer attempts per patient reached7.3 → 4.0.
Two customers, prior care management platform vs Kairon, 2025–2026. Measured in production.
What changes
What changes for your care team
Transitions of care, care management, coding and quality each run in a separate tool with its own login.
One worklist holds every program. Tasks are created by their trigger and assigned by role.
Launching a new clinical program means another vendor contract and another implementation.
A new program is configuration on the same engine, with its own triggers and escalation rules.
Coders submit HCCs with no structured check before the payer sees them.
Each suspect moves through screening, QA sampling and clinical validation before it is marked ready to transmit.
How it works
From discharge to closed loop
A trigger creates the task
A hospital discharge, a suspect rule match or an open quality gap puts the patient on the worklist.
The right role picks it up
Work routes to the nurse, pharmacist, coder or quality lead who owns it, by program and practice access.
The call has context
Claims, ADT, lab and pharmacy history sit beside the task, so the care manager starts with the full picture.
The loop closes
Discharge-to-contact times, gap closures and coding outcomes are tracked for every program on the list.
From the Care Graph demo, on illustrative data.
What’s inside
Four programs, one worklist
Transitions of care
A hospital discharge opens a case automatically. Contact within 48 hours and TCM visits within 7 and 14 days are tracked for every patient.
Care management programs
Longitudinal, chronic disease and pharmacist-led programs run on one engine. AI builds and updates a care graph for each patient from every clinical conversation.
HCC coding review
A four-stage review with a suspect rule library and QA sampling, ending in a ready-to-transmit decision.
Quality gap closure
30+ HEDIS® measures plus Part D adherence and CAHPS Stars measures, with gap worklists refreshed nightly and routed by practice access.
NCQA Prevalidated for Population Health Management. Clients using Kairon's Care Operations Module receive automatic credit on Data Integration and Case Management Systems during NCQA accreditation surveys.
Built for
Who works the list
Care Managers
One caseload across programs, with the patient’s recent history in view before every call.
Pharmacists
Chronic disease protocols with medication adherence gaps on the same list.
Health Coaches
Longitudinal follow-up on the same worklist as the clinical team.
Medical Coders
Suspect review and QA in one queue, with a clear ready-to-transmit step at the end.
Quality Specialists
HEDIS® and Stars gaps refreshed nightly and routed to the people who can close them.
Related use cases
Two workflows to start with
Where this sits
- Fed by your data Your data is messy. Our platform doesn’t care.
- Care OperationsCare management, coding and quality on one worklist
- Measured in Impact Analytics Studies test whether this work moved the number, while you can still change course.
See your programs on one worklist.
Tell us which programs you run today. We’ll show you how they sit together on one worklist and how each one is measured.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).