The member your five systems each know a fifth of.
Care management runs on triage, and triage runs on whoever’s list arrived that morning. The constraint is almost never clinical judgment — it’s that no single view exists of who is deteriorating, who is expensive for reasons anyone can act on, and who is already being managed.
Cost concentration you can actually act on
High-cost rankings built on total spend surface members whose cost is capitation and supplemental benefits — accurate and useless to a care manager. Alberto ranks on clinical cost only, over complete months, with the denominator stated. The list that comes back is the list where intervention is still possible.
Risk that names its own evidence
Readmission and admission risk, published risk indices validated against your own outcomes rather than quoted from a paper, frequent-utilizer identification on windows that end today rather than at the last closed month, and homebound identification built from dozens of independent signal families — documented confinement, functional dependence, and trajectory — banded by strength and drillable to the dated events that produced the score.
A member’s score is never the output. The evidence behind it is, because that’s what a nurse needs to make a call.
Managed, unmanaged, and honest about which
Who is already in a program, who opted out, and who is high-risk and touched by no one. Members already being managed are flagged, never hidden — a list that quietly drops them is how two departments end up working the same member and neither one knows.
Is the care plan treating what we’re being paid for?
The question that sits exactly between care management and risk adjustment, which is why a stack of specialists can’t answer it. One query here: the member’s conditions, what’s documented, what’s credited, what the care plan addresses, and where those three disagree.
Every dashboard reports complete months only — the current month is never shown, because a partially reported month looks like improvement. Where data coverage varies by cycle, low-coverage periods are excluded from the headline, drawn differently, and named on the page rather than averaged into a trend.
The list where intervention is still possible — with the evidence a nurse needs beside every name.