PAYERS . PROVIDERS . TPAs . RISK-BEARING ORGANIZATIONS .
Your members are telling
you something.
Most platforms can't
hear it.
Mpowered Health's platform unifies every signal across your population — claims, clinical, pharmacy, SDOH, and live events — and turns it into coordinated action across your operations automatically. Enrollment & onboarding, care coordination, risk management, quality programs, utilization management, member services, and compliance: running in weeks, not quarters. No custom engineering. Guaranteed outcomes.
3x member engagement
Deploys in weeks
No custom engineering
30% fewer avoidable admissions
CMS Compliant
80% lesser manual coordination
3x
Higher member engagement vs. single-channel outreach
how it works
Every signal across your population.
Automatically turned into action.
Most platforms stop at insight — giving you dashboards that show you what's wrong without fixing it. Our platform's Know Your Member™(KYM) capabilities connects real-time member intelligence directly to the workflows and the people or agents who act on it, then tracks every outcome back to what caused it.
Step 01 — know
See every gap, risk, and opportunity.
Before it becomes a problem.
KYM continuously updates the whole-person profile for every member — pulling from your own systems, providers, payers, pharmacies, SDOH sources, and the member's home. Risk, gaps, and opportunities surface automatically, in real time. Your team can stop chasing the data and start acting on it.
STARs & HEDIS gap identification
Open quality measure gaps surfaced per member — so care teams know exactly who to reach and what's missing.
Rising-risk & utilization signals
Hospital events, chronic condition flags, and social barriers identified in real time — before they drive avoidable cost.
STARs gap detection
SDOH barriers
Risk stratification
Member engagement intelligence
KYM learns how each member prefers to be reached — channel, timing, language, and health literacy — so outreach lands when and how it's most likely to get a response, not just when it's convenient to send.
Engagement preferences
Whole person view
Risk caught before it costs
Intervene before ED visits and admissions
30%
Reduction in avoidable ED visits & preventable admissions
Gaps flagged AND closed
Every open measure tied to an action
Step 02 — ACT
Complex programs running automatically.
Across your whole population.
KYM turns member signals into coordinated action across care management, UM, quality, and compliance — without manual hand-offs or dropped tasks. Teams configure programs once; the platform handles execution at scale, from a single member to an entire population.
Interdisciplinary team task orchestration
The right task reaches the right team — care managers, UM staff, community health workers — with no dropped hand-offs between programs or departments.
Enrollment & onboarding
Real-time care navigation
UM & prior auth
Care transitions
End-to-end program execution
Enrollment, care coordination, member services, UM & prior-auth, risk & quality programs run automatically — triggered by member and system signals, not manual intervention.
Referral intake
Ops that run themselves
Powered by ai-agents, people or both
80%
Reduction in manual care coordination touchpoints
Compliance built in
CMS, HEDIS, and state requirements handled
Step 03 — PROVE
Know what's working and what's not.
Results you can show leadership.
Every outreach, intervention, workflow and outcome is linked to the quality measure, cost target, VBC contract or any performance metric it's driving. Leadership always knows what's working — and where to push harder — before the measurement period closes.
STAR, HEDIS & VBC performance tracking
Live measure-level progress against your performance targets — so you know which gaps are closing and which contracts are at risk.
Program ROI & outcome attribution
Every care management program, outreach campaign, and workflow tied back to the cost savings and quality improvements it produced.
Real-time STARs & HEDIS
VBC contracts
ROI attribution
4x
Faster program activation vs. legacy platforms
Rapid deployments
Live in weeks. No custom engineering
The problems your team is
dealing with right now.
what we solve
Every week a rising-risk member goes unidentified is a preventable admission. Every open STARs gap that isn't acted on is a rating point at risk. Every manual workflow your team runs is capacity that isn't going to members who need it. KYM closes those gaps — across your whole population and your operations - automatically, from day one.
reduced unnecessary medical cost and improved quality
Intervene before members end up in the ED
Identify rising-risk members early and trigger timely outreach, navigation, and care coordination — before emergency utilization happens.
Stop preventable 30 day readmissions
ADT-triggered post-discharge workflows schedule follow-ups, verify medication reconciliation, and flag readmission risk the moment a member leaves the hospital.
Close the quality gaps that decide your STARs & HEDIS scores
Real-time insights and embedded workflows push actions to the right care team — with continuous performance dashboards tied to STARs and VBC targets.
Detect high-cost risk early and orchestrate interventions, documentation, and reporting workflows to manage stop-loss exposure — with automated workflows to streamline submission.
Streamline stop-loss claims
Stop losing members at enrollment
Automated eligibility, enrollment, and onboarding workflows reduce drop-off, improve conversions, and eliminate the downstream errors that create cost later.
improved operating efficiencies
End manual intake
Automate intake across fax, email & phone — collection of consents, medical records, documents, and bill payments to accelerate access and reduce manual effort.
Cut prior auth turnaround times
Automated intake, clinical criteria evaluation, status tracking, and decision communication — reducing PA burden for both plans and providers while meeting CMS 0057.
Get every team working from the same page
Align care management, pharmacy, behavioral health, and social services around a shared member view — across organizations, without information gaps.
Guide members to the right care before it's too late
Real-time KYM intelligence surfaces clinical, benefit, and SDOH context — so members get directed to the right setting before avoidable utilization occurs.
Reduce call volume without reducing service quality
Shift common inquiries to digital self-service or automated agent support while routing complex issues to the right team — at the right time.
Iimproved compliance
Handle Medicaid redeterminations at scale
Automated eligibility redetermination workflows track status, trigger outreach to at-risk members, and process documentation per state-specific requirements — without adding headcount.
Deploy ePriorAuth APIs that meet CMS 0057
Secure, standards-based ePriorAuth APIs with full audit trail, clinical criteria evaluation, and decision traceability — built in, not bolted on.
Meet CMS 9115 Patient Access requirements from day one
FHIR-native patient access, provider directory, and payer-to-payer APIs with tokenized access and full audit logging — deployed and compliant without building from scratch.
Eliminate member cost surprises and meet CMS 9915 requirements
Real-time, personalized cost estimates that integrate benefits, network status, and procedure costs — meeting CMS 9915 requirements while improving member trust.
Self-service, care management, scheduling, payments, and assessments in a single branded experience — reducing inbound calls and driving activation from day one.
Give members one place to manage their health
improved member engagement
Personalized, omnichannel outreach — driven by KYM member intelligence — so the right message reaches the right person at the right moment across every touchpoint.
Reach members through channels they actually use
Who We Serve
Payers
Health Plans · MA & SNP · Medicaid · Commercial · Exchange
Health plans use KYM to identify high-risk members early, automate care coordination, close quality gaps, and remain compliant — without burdening IT or adding headcount.
STARs & HEDIS performance — targeted gap closure that moves quality scores where plans need them most.
MLR & ALR reduction — reduced over-utilization and administrative efficiencies across member services.
Grow revenue, control cost,
hit quality targets — at once.
Member retention — personalized, proactive care coordination that improves satisfaction and keeps members enrolled.
Providers
ACOs · Health Systems · Medical Groups · Risk-Bearing Providers
Providers use KYM to access coordinated member intelligence, automate intake and care workflows, reduce administrative burden, and operate from a single source of truth across payer and clinical data.
Avoidable readmissions reduction — risk stratification and proactive coordination reduce preventable ED visits and readmissions.
Automated referral & eligibility — fax and email referrals processed automatically with real-time eligibility checks.
Close gaps faster.
Operate smarter under risk.
VBC performance — real-time shared savings tracking with workflows that keep programs on track.
TPAs & Brokers
Third-Party Administrators · Benefits Advisors · Self-Insured Employers
TPAs and brokers use KYM to move from retrospective reporting to proactive cost management — delivering measurable outcomes employers can see at renewal without building their own infrastructure.
Medical cost reduction — targeted, data-driven interventions addressing specific cost drivers in each employer population.
UM & stop-loss automation — proactive workflows that reduce unnecessary spend before claims are filed.
Move beyond reporting.
Deliver outcomes employers renew for.
Employer ROI reporting — real-time dashboards that demonstrate measurable outcomes and drive renewal confidence.