Your systems have gaps.
We close them - and we make everything
work better.
Healthcare organizations run on a patchwork of systems — each solving part of the problem, none solving all of it. Mpowered doesn't replace what's working. We augment your existing infrastructure, close the gaps between your EHR, claims platform, and care management tools, and layer in the engagement, automation, and agentic AI your current stack was never built to deliver.
Better operations
Smarter teams across every function
Care management, member services, risk, quality, and operations all work from unified workflows, real-time data, and AI-assisted tools — reducing friction and increasing capacity without adding headcount.
Better engagement
Members reached, activated, and retained
Personalized, timely outreach that connects high cost and high-risk members to the right programs, care pathways, and support — across every channel they actually use.
Improved outcomes
Results that move the needle for your organization
Lower cost of care, stronger quality scores, reduced avoidable utilization, and measurable ROI — outcomes your leadership, board, and members will see.
Three core engines
Activation & Engagement
Reach the right high cost member
at the right moment.
Clinical signals, utilization patterns, and social determinants of health combine to activate personalized, compliant outreach — connecting high cost members to the right care pathways before costs escalate further.
High cost member identification
Risk stratification surfaces members with complex, chronic, or catastrophic conditions driving disproportionate spend.
Omnichannel member outreach
Coordinated touchpoints across care management, digital, and phone — meeting members where they are.
Care gap closure
Targeted programs that move high cost members into evidence-based care pathways and drive adherence at scale.
Risk stratification
SDOH integration
Care gap closure
Utilization signals
Workflow Automation
Eliminate the friction
that slows care coordination down.
Manual handoffs between care managers, payers, and providers cost time and outcomes. Mpowered automates the workflows that keep high cost members connected to care — without custom engineering or workarounds.
Prior authorization & referral flows
Approval workflows routed, tracked, and resolved — reducing delays that drive avoidable utilization.
Eligibility & enrollment
Automated eligibility verification and program enrollment — no eligible member falls through the cracks.
Cross-team coordination
Connects care managers, clinical teams, and payer systems so every stakeholder operates from one source of truth.
No-code workflow builder
EHR & claims integration
Eligibility verification
HIPAA-ready
Care management automation
Case creation, escalation routing, and follow-up triggers fire automatically on clinical and utilization events.
Agentic AI Orchestration
AI that acts, adapts,
and bends the cost curve.
Mpowered's agentic layer goes beyond automation — AI agents reason across claims, clinical, and behavioral data to predict risk, coordinate complex care journeys, and intervene before high cost events occur.
Predictive cost & risk detection
AI surfaces members at risk of escalation, readmission, or care gap deterioration — before they become crises.
Autonomous care journey orchestration
Agents manage complex, multi-stakeholder care sequences end-to-end — adapting in real time to member response.
Continuous cost optimization
Every interaction feeds a learning loop that refines interventions, improving outcomes and reducing spend over time.
Multi-agent coordination
Claims & clinical reasoning
Human-in-the-loop
Governed AI
Platform capabilities
One platform. One source of truth. Infinite possibilities for impact. Every capability is built on a shared intelligence layer — so data, decisions, and actions flow seamlessly across your entire operation.
A continuously updated longitudinal member profile unifying claims, clinical, pharmacy, labs, SDOH, eligibility, utilization, and engagement signals. KYM drives personalization, risk stratification, and proactive intervention — at scale.
Longitudinal record
SDOH & behavioral data
Know Your Member™ Intelligence
The foundation of everything member
Risk stratification
Real-time signals
Built for connection. Designed for action.
Interoperability & Data Exchange
A FHIR-native, backward-compatible engine with native support for HL7, X12, APIs, and flat files. Real-time ingestion of ADT, claims, prior auth, and care events with bi-directional exchange across the ecosystem — meeting CMS mandates while powering live operational workflows.
FHIR & HL7 native
Real-time ingestion
CMS mandate ready
Tokenized API gateway
Event-driven, rules-based workflows spanning enrollment, care coordination, utilization management, risk & quality, customer support, and compliance. Task routing, workload balancing, and SLA management ensure the right action happens at the right time — for human and agentic workflows alike.
No-code builder
SLA management
Workflow Orchestration
From signal to resolution
Event-driven triggers
Workload balancing
Purpose-built AI agents that surface next-best actions, automate triage and prioritization, and assist care teams with summaries, recommendations, and documentation. Designed for transparency, control, and compliance — AI that healthcare organizations can trust.
Next-best action
Human-in-the-loop
Embedded AI Agents
Operational intelligence, always on
Automated triage
Explainable AI
Omnichannel outreach and program execution powered by KYM insights — spanning enrollment & onboarding, STARs & quality improvement, risk adjustment, medication adherence, chronic care engagement, and member retention. Closed-loop tracking links outreach directly to outcomes.
Omnichannel delivery
Closed-loop tracking
Campaign & Program Management
Precision execution at scale
STARs & HEDIS
Risk adjustment
Track performance across utilization, cost, risk, quality, and engagement. Monitor STARs, VBC, and contract performance alongside workforce productivity and SLA adherence. Executive-level visibility that turns real-time insight into continuous improvement.
STARs & VBC tracking
SLA adherence
Performance Management & Analytics
Measure impact. Optimize continuously.
Workforce productivity
Executive dashboards
Built-in support for CMS interoperability, prior authorization, and price transparency mandates — alongside state-specific eligibility, enrollment, and reporting requirements, STARs, HEDIS, and risk adjustment. Role-based access, data lineage, and decision traceability ensure every action is tracked, defensible, and auditable.
CMS mandates
Compliance, Governance & Auditability
Compliance by design
HIPAA & state compliance
STARs & HEDIS
Data lineage
Decision traceability
Role-based access
Why Mpowered Health
KYM-first architecture
Not point solutions
Real-time intelligence
Not retrospective reporting
Actionable workflows
Not alerts
Compliance embedded
Not bolted on
Configure & deploy
No coding required
3x
higher engagement vs. single-channel member outreach
80%
reduction in manual care coordination touchpoints
24/7
AI agents monitoring every high cost member journey
4x
faster program activation vs. legacy platforms
Your existing systems work hard.
Mpowered makes them work smarter — and closes every gap in between.