Start with members who have a supported reason for care-management attention.
Burse™ organizes care-management opportunities around defined, actionable member needs—not broad risk lists that leave the care manager to determine why the member was surfaced.
Surface members with meaningful clinical complexity and utilization who warrant structured care-management review and intervention.
Surface members whose recent clinical or utilization signals indicate an emerging need for care-management attention.
Identify members with emergency-department use that warrants review of access, follow-up needs, or underlying barriers.
Create timely transition workflows to assess discharge needs, medication access, appointments, and follow-through.
Identify members with no PCP visit in the prior 24 months and organize outreach to reconnect them with primary care.
Understand the member before outreach begins.
The care manager should be able to answer two questions immediately: Why is this member here? and What should I understand before I contact them?
Recent hospitalization with follow-up and access needs that warrant care-management review.
Contact the member within 2 days to assess transition status, medication access, PCP follow-up, and immediate barriers.
Transportation • medication affordability • appointment access • engagement
Build member-specific care plans around measurable outcomes.
For each care-management opportunity, Burse™ uses the member's available data and opportunity type to create a tailored care plan with one or more goals, the work needed during Intake and Follow-Up, and a time-bound measure for determining whether each goal was achieved.
Define one or more outcomes care management should meaningfully influence for this member based on the opportunity and available member data.
Associate each goal with a defined measure and timeframe so the team can determine whether the intended outcome was achieved.
Generate Intake tasks for work that can happen now and Follow-Up tasks for reassessment, verification, or action that must occur later.
Connect barriers, interventions, and outreach to the goal they affect; coordinate with the member, caregivers, or care team; add work when needed; or document when the goal is no longer achievable.
Separate what the care manager can do now from what can only be verified later.
Burse™ generates Intake and Follow-Up work around the member's specific goals. Intake captures the assessment and actions that can happen now; Follow-Up returns verification, reassessment, and unresolved work when time has passed or a future event has occurred.
Act on what can be assessed or initiated now.
Bring future verification and reassessment back when due.
Intake and Follow-Up show what work occurred. The goal measure determines whether the intended outcome was achieved within the defined timeframe.
Keep outreach and follow-through connected to the work.
Coordinate communication with members, authorized family members or caregivers, and the provider care team. Care managers can text members directly from Burse™ where messaging is enabled and consent requirements are met, and securely message PCPs and specialists through workflows integrated with the provider's EHR. Communication history, responses, and resulting follow-up stay connected to the member's care plan and opportunity.
Know what was done—and whether the intended outcome was achieved.
Burse™ separates task completion from goal achievement. Intake and Follow-Up activity shows what the team did; the goal's time-bound measure shows whether the intended outcome was achieved, remains unresolved, or requires additional action.
See a care-management workflow built around accountable follow-through.
Walk through member prioritization, clinical context, measurable goals, intake and follow-up, outreach, barriers, and resolution in Burse™.