Real problems. Real outcomes.
See how organizations use Mpowered.
From closing quality gaps to managing high-cost members in real time, Mpowered powers the workflows that matter most — across health plans, providers, and plan administrators. Every use case is live and deployable today.
3x
higher member engagement vs. single-channel outreach
30%
reduction in avoidable ED visits and preventable admissions
8x
faster program activation vs. legacy platforms
Member Experience & Engagement
Payers · Providers
Digital Member Onboarding & Welcome Journey
Turn new enrollment into early activation. Automated welcome campaigns, benefits education, and PCP attribution prompts delivered across app, SMS, and email — all triggered by the enrollment event.
Higher activation rates
Members who engage in the first 30 days have measurably better long-term retention and compliance.
Fewer inbound service calls
Proactive benefits education reduces "how do I use my plan" inquiries and customer service burden.
Omnichannel outreach
KYM intelligence
Event triggers
See it in action ->
Payers · TPAs
Chronic Condition Engagement Programs
Identify members with diabetes, CHF, COPD, or other chronic conditions and enroll them into structured engagement programs — personalized to their risk level, language preference, and channel behavior.
Improved medication adherence
Timely, relevant reminders close adherence gaps before they escalate into avoidable events.
Measurable HEDIS improvement
Chronic condition management programs directly move diabetes care, hypertension control, and medication measures.
Risk stratification
HEDIS tracking
Personalized outreach
See it in action ->
Payers · Providers
Proactive Annual Wellness Visit Scheduling
Surface members overdue for AWVs or preventive screenings and launch targeted campaigns to schedule visits — closing care gaps, capturing risk codes, and improving STARs measures simultaneously.
STARs & quality lift
Preventive care visits are among the highest-impact levers for improving STARs ratings and HEDIS scores.
Care gap closure
Appointment scheduling
See it in action ->
STARs programs
Care Management & Coordination
Payers · Providers
Complex Care Management for High-Risk Members
Identify members with the highest predicted cost and clinical risk. Automatically assign them to care managers, populate longitudinal care plans, and track intervention progress across all touchpoints.
Lower per-member costs
Intensive, coordinated management of high-risk members yields the highest cost-reduction ROI of any program type.
Faster care team response
AI-driven prioritization ensures care managers spend time on the members who need them most, not the loudest.
Risk stratification
Care plan management
See it in action ->
AI triage
Payers · TPAs
Automatically trigger post-discharge workflows when a hospital ADT notification arrives — scheduling follow-up calls, verifying medication reconciliation, and flagging readmission risk within hours of discharge.
Post-Discharge Transition of Care
Readmissions prevented
Timely post-discharge follow-up is proven to reduce 30-day readmissions — a top cost and quality driver.
ADT notifications
Workflow automation
FHIR integration
See it in action ->
Payers · Providers · TPAs
Interdisciplinary Care Team Collaboration
Give care managers, clinical pharmacists, behavioral health specialists, and social workers a shared real-time view of every member — with role-based workflows that eliminate handoff gaps and duplicated outreach.
Coordinated interventions
A unified member view means every team member acts on the same data — no conflicting outreach, no dropped handoffs.
KYM intelligence
Role-based access
Task routing
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Payers · Providers
SDOH Screening & Community Resource Connection
Identify social determinants — food insecurity, housing instability, transportation barriers — through assessments and claims signals, then automatically connect members to community resources and track resolution.
Whole-person care
Addressing social needs alongside clinical ones reduces avoidable utilization and improves health equity metrics.
SDOH data
Assessments
Community resources
See it in action ->
Providers · TPAs
Behavioral Health Integration & Navigation
Identify members with unmet behavioral health needs through claims and risk signals, coordinate warm handoffs to behavioral health providers, and ensure follow-through with closed-loop tracking.
Closed care gaps
Behavioral health integration prevents high-cost crises — ED visits, inpatient admissions — that stem from untreated mental health conditions.
ADT notifications
Workflow automation
FHIR integration
See it in action ->
Care Management & Coordination
Payers · TPAs
Predictive High-Cost Claimant Detection
Combine claims history, clinical signals, and AI models to identify members on a trajectory toward catastrophic spend — before a crisis event triggers the cost. Intervene early with coordinated outreach and care management enrollment.
Bend the cost curve
Catching high-cost trajectories 60–90 days early creates a meaningful intervention window that can reduce peak spend by 20–40%.
Predictive AI
Proactive outreach
Claims reasoning
See it in action ->
TPAs · Self-Insured Employers
Stop-Loss Management & Reporting
Detect members approaching stop-loss thresholds in real time. Orchestrate clinical interventions, capture supporting documentation, and automate stop-loss submission workflows — reducing submission errors and maximizing recoveries.
Maximized stop-loss recovery
Automated tracking and documentation capture every eligible claim — reducing missed recoveries from incomplete submissions.
Threshold monitoring
Submission reporting
Workflow automation
See it in action ->
Payers · Providers
Identify members with suspected HCC coding gaps using claims and clinical data. Drive outreach campaigns to close documentation gaps, coordinate chart reviews, and ensure accurate risk score capture before the coding deadline.
Risk Adjustment Optimization
Improved risk score accuracy
Closing documentation gaps ensures revenue is accurately captured and members are properly enrolled in appropriate programs.
HCC coding
Chart review workflows
Risk adjustment
See it in action ->
Payers · Providers · TPAs
STARs, HEDIS & Value-Based Performance
Operationalize quality programs with real-time gap identification, automated member outreach, and performance tracking across all HEDIS measures and value-based contract terms — with full attribution back to interventions.
Measurable STARs improvement
Targeted gap closure and provider collaboration move the measures that matter most before the measurement period closes.
STARs tracking
VBC analytics
HEDIS measures
See it in action ->
Operations & Administration
Payers · TPAs
Automated Eligibility & Enrollment Operations
Automate eligibility verification, enrollment processing, and member onboarding across all lines of business — eliminating manual data entry, reducing downstream eligibility errors, and accelerating time to coverage.
Faster enrollment cycles
Automated processing reduces enrollment-to-activation timelines from days to hours, improving member experience from day one.
Eligibility automation
Enrollment workflows
See it in action ->
CMS compliance
TPAs · Self-Insured Employers
Automated Patient & Referral Intake
Process referrals arriving via fax, email, or phone automatically — extracting key data, verifying eligibility, routing to the appropriate care team, and confirming receipt to the referring provider without manual intervention.
Eliminated leakage & delays
Automated intake means no more lost faxes or delayed referrals — and full visibility into referral status at every step.
Fax & email extraction
Auto-routing
Real-time eligibility
See it in action ->
Payers · Providers
Medicaid Redetermination & Eligibility Continuity
Automate eligibility redetermination workflows at scale — tracking member status, triggering outreach to members at risk of losing coverage, and processing documentation according to state-specific requirements and timelines.
Continuous coverage protection
Proactive outreach and automated documentation workflows prevent unintended coverage lapses that drive worse health outcomes.
State-specific rules
Document processing
Automated outreach
See it in action ->
Payers · Providers · TPAs
Automate PA intake, clinical criteria evaluation, status tracking, and decision communication — reducing turnaround time from days to hours while improving decision consistency and audit defensibility.
Prior Authorization Automation
Faster decisions, less friction
Members and providers get faster PA decisions — reducing care delays, provider abrasion, and costly peer-to-peer calls.
ePriorAuth (CMS 0057)
Clinical criteria
See it in action ->
Audit trail
Quality & Compliance
Payers · Providers
CMS Interoperability & Patient Access APIs
Deploy FHIR-native patient access, provider directory, and payer-to-payer APIs that meet CMS 9115 and CMS 0057 requirements — with tokenized access, audit logging, and real-time data availability for members and providers.
Mandate compliance, day one
Avoid CMS penalties while improving member access to their own health data — a dual win for compliance and experience.
CMS 9115
FHIR APIs
Audit logging
See it in action ->
Payers · Providers · TPAs
Audit Readiness & Decision Traceability
Maintain complete, immutable records of every decision, action, and data change across the platform — with role-based access controls and decision lineage that support internal audits, CMS reviews, and regulatory inquiries.
Defensible decisions
Every AI-assisted action and workflow step is logged with the data and logic that drove it — making audit responses fast and airtight
Data lineage
Decision traceability
Role-based access
See it in action ->
Payers · TPAs
Price Transparency & Cost Estimation
Provide members with real-time, personalized cost estimates before they receive care — integrating benefits, network status, and procedure costs to support informed decisions and comply with CMS price transparency mandates.
Reduced surprise bills
Members with cost visibility before receiving care are more likely to choose in-network providers and high-value settings of care.
CMS 9915
Cost estimation
See it in action ->
Benefits integration
Growth & Retention
Payers · TPAs
Identify members at risk of voluntary or involuntary disenrollment using behavioral signals, satisfaction scores, and engagement patterns. Trigger proactive retention campaigns that address the root cause — whether it's benefit confusion, access friction, or unmet care needs.
Member Retention & Disenrollment Prevention
Improved retention rates
Retaining a member costs a fraction of acquiring a new one — and retained members drive better long-term quality and cost outcomes.
Employer renewal confidence
For TPAs, demonstrable member satisfaction and measurable cost outcomes directly influence employer renewal decisions.
Disenrollment signals
Satisfaction tracking
See it in action ->
Payers · TPAs
Generate real-time, employer-level performance dashboards that show program engagement, cost trends, population health outcomes, and ROI — giving account managers the data they need to retain and grow their book of business.
Employer Reporting & ROI Demonstration
Renewal-ready reporting
Clear, measurable outcomes tied directly to programs and interventions give employers compelling reasons to renew and expand.
Competitive differentiation
Real-time employer reporting is a differentiator in a market where most competitors still deliver PDF reports at year end.
Employer dashboards
Cost trend tracking
ROI attribution
See it in action ->
80%
reduction in manual care coordination touchpoints