The AI-enabled, no-code
orchestration platform
for smarter healthcare operations
Our Know Your Member™ (KYM) platform turns fragmented data into coordinated action — across payers, risk-bearing providers, partners, members, and caregivers. From insight to action. From data to outcomes. From compliance to performance.
No custom engineering
Measurable outcomes
Deploys in weeks
FHIR-native
CMS-compliant
AI-driven
3x
Higher member engagement vs. single-channel outreach
30%
Reduction in avoidable ED visits & preventable admissions
80%
Reduction in manual care coordination touchpoints
8x
Faster program activation vs. legacy platforms
From insight to action.
Three engines. One platform.
The KYM Platform
KYM connects real-time member intelligence with automated workflow orchestration and agentic AI execution — so every insight becomes an action, and every action is tracked to an outcome.
Step 01 — Unify
Real-time member 360
you don't have to build.
KYM ingests and continuously refreshes historical and real-time data from providers, payers, pharmacies, SDOH sources, and internal systems — building a longitudinal whole-person profile for every member that surfaces risk, gaps, and opportunities automatically.
Know Your Member™ profiles
Claims, clinical, pharmacy, SDOH, eligibility, and engagement signals unified and refreshed in real time.
Real-time ADT & event ingestion
Hospital admissions, discharges, prior auth events, and care signals processed the moment they occur.
FHIR & HL7
Claims & clinical
SDOH
Risk stratification
Step 02 — Orchestrate
No-code workflows.
Agentic AI execution.
Event-driven, rules-based workflows spanning enrollment, care coordination, UM, quality programs, and compliance — configured without custom engineering. AI agents then prioritize, route, and automate the steps that don't require human judgment.
Agent-supported automation
AI agents surface next-best actions, automate triage, and handle high-volume tasks that drain team capacity.
No-code builder
Event triggers
AI agents
Task routing
No-code workflow builder
Clinical and operations teams configure complex workflows themselves — no IT tickets, no development cycles.
Step 03 — Measure
Real-time performance.
Guaranteed outcomes.
Executive dashboards track STARs, VBC, cost, quality, and engagement in real time — with closed-loop outcome tracking that links every outreach and workflow directly to the result it produced. Rapid, low-cost deployment with measurable improvements in performance, guaranteed.
STARs & VBC performance dashboards
Real-time quality measure tracking tied to the workflows and outreach programs that drive them.
Closed-loop outcome tracking
Every action linked to the outcome it produced — so leadership always knows what's working.
STARs & HEDIS
VBC contracts
ROI attribution
KYM-first architecture
Not point solutions
Real-time intelligence
Not retrospective reporting
Actionable workflows
Not alerts
Compliance embedded
Not bolted on afterward
Configure & deploy
No coding required
Member Experience
All digital endpoints in one place — member self-service, support interactions, care management, scheduling, payments, and assessments. A branded experience that reduces inbound calls and drives early activation.
Next-Gen Digital Front Door
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Understand how members engage across departments and channels, and optimize engagement with personalized, omnichannel outreach — driven by KYM intelligence — to drive the outcomes that matter most.
Unified Member Engagement
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Operataions
Automated Eligibility, Enrollment & Onboarding
Automate eligibility checks, enrollment, and onboarding workflows to reduce friction, improve application conversions, and eliminate downstream operational issues.
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Automate intake across fax, email & phone — collection of consents, medical records, documents, and bill payments to accelerate access and reduce manual effort.
Automated Patient Intake
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Automate intake across fax, email & phone — collection of consents, medical records, documents, and bill payments to accelerate access and reduce manual effort.
Automated Prior Authorization
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Interdisciplinary Care Team Collaboration
Align care management, pharmacy, behavioral health, and social services around a shared member view — enabling care teams across organizations to collaborate without information gaps.
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Care Navigation
Guide members to the right care, at the right time, and in the right setting — based on real-time clinical, benefit, and SDOH context surfaced by KYM.
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Reduce Customer Support Overheads
Shift common inquiries to digital self-service or AI agent-led support while routing complex issues to the right team — reducing call volume without reducing service quality.
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Compliance
Medicaid Eligibility Redetermination
Automate eligibility redetermination workflows at scale — tracking status, triggering outreach to at-risk members, and processing documentation per state-specific requirements.
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Deploy FHIR-native patient access, provider directory, and payer-to-payer APIs with tokenized access and audit logging — meeting CMS 9115 requirements from day one.
Patient Access APIs
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Expose secure, standards-based ePriorAuth APIs to support CMS 0057 requirements — with full audit trail, clinical criteria evaluation, and decision traceability built in.
Electronic Prior Authorization
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Price Transparency
Provide real-time, personalized cost estimates before members receive care — integrating benefits, network status, and procedure costs to comply with CMS 9915 and reduce surprise bills.
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Cost & Risk
Reduce Avoidable ED / ER Visits
Identify rising-risk members early and intervene with timely outreach, navigation, and care coordination — before emergency utilization occurs.
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Automatically trigger post-discharge workflows on ADT events — scheduling follow-ups, verifying medication reconciliation, and flagging readmission risk within hours of discharge.
Reduce Hospital Readmissions
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Detect high-cost risk early and orchestrate interventions, documentation, and reporting workflows to manage stop-loss exposure — with automated submission built in.
Stop-Loss Management
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STARs, Value-Based Care & Quality Management
Operationalize quality programs with real-time insights, embedded workflows that push actions to the right care team, and continuous performance dashboards tied to STARs and VBC targets.
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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.
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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 utilization 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.
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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.
Explore TPA & Broker Solutions ->
Step 01 — Unify
Real-time member 360
you don't have to build.
KYM ingests and continuously refreshes historical and real-time data from providers, payers, pharmacies, SDOH sources, and internal systems — building a longitudinal whole-person profile for every member that surfaces risk, gaps, and opportunities automatically.
Know Your Member™ profiles
Claims, clinical, pharmacy, SDOH, eligibility, and engagement signals unified and refreshed in real time.
Real-time ADT & event ingestion
Hospital admissions, discharges, prior auth events, and care signals processed the moment they occur.
FHIR & HL7
Claims & clinical
SDOH
Risk stratification
Step 01 — Unify
Real-time member 360
you don't have to build.
KYM ingests and continuously refreshes historical and real-time data from providers, payers, pharmacies, SDOH sources, and internal systems — building a longitudinal whole-person profile for every member that surfaces risk, gaps, and opportunities automatically.
Know Your Member™ profiles
Claims, clinical, pharmacy, SDOH, eligibility, and engagement signals unified and refreshed in real time.
Real-time ADT & event ingestion
Hospital admissions, discharges, prior auth events, and care signals processed the moment they occur.
FHIR & HL7
Claims & clinical
SDOH
Risk stratification