Care Management

Jiva™ transforms traditional healthcare management into true population health management

Jiva™, our population health management solution, transforms traditional episodic-based care management into proactive and collaborative population health management through electronic health record (EHR)-enabled care plans, point of care tools, decision support, and user-configurable workflows for care management. And our portal services connect stakeholders  to ensure seamless care and collaboration.

Jiva’s web-based care management application is built using AJAX technology. Its modular design allows companies to easily configure and selectively deploy modules. Jiva is HIPAA and ICD-10CM/PCS compliant.

Jiva revolutionizes care management by delivering:

  • An integrated real time rules-driven workflow application that promotes transparency between utilization management, care management and disease management functions
  • Embedded clinical analytics to stratify the population risk, identify gaps in care and deliver personalized care plans
  • Integrated workflow for health, wellness and lifestyle support programs complemented by content from health risk assessments and clinical protocols and business rules
  • Capabilities for multi-channel communications that can deliver personal health records, patient decision aids, health management tools, clinical content for health education and decision support tools at the point of care
  • The ability to exchange data with external systems, consolidate information across disparate data sources and present this information through web services to physicians, individuals and care managers

Real Time, Rules-driven Workflow Application
Jiva’s care management platform integrates workflows across the care management continuum, automates workflows intelligently based on client business rules, enables identification, stratification and engagement of patients and high risk members, and facilitates multi-channel communication and collaboration between individuals, providers and stakeholders.


Our platform supports group or individual processes for the private sector, and Medicaid and Medicare specific workflows for the public sector. Jiva’s Sentinel Rules Engine (SRE) goes beyond automating individual workflows to automating business processes across the entire care management continuum. This is performed in real time. The SRE also simplifies the configuration and maintenance of these business rules through an intuitive user interface that enables clients to either modify pre-packaged rules or create rules specific to their requirements.


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Embedded Clinical Analytics
Jiva’s care analytics focuses on providing relevant clinical intelligence that is actionable and integrated into the care management business rules and processes. Our solution analyzes medical and pharmacy claims, medications, lab and diagnostic data, health risk assessments, and electronic medical record (EMR) clinical data from disparate data sources. The solution identifies and stratifies high risk individuals, those with chronic conditions and gaps in care. Jiva takes this clinical intelligence and makes it actionable by applying additional client criteria and automating actions such as sending alerts, generating referrals or generating interventions to address these care management opportunities. Our solution also works with third party predictive modeling applications.

Advanced Assessment Configuration Engine (ACE)
The Advanced ACE within Jiva focuses on collecting meaningful information from clients, analyzing this information and driving workflow activities. Advanced ACE is used to configure content such as clinical protocols, health risk assessments, questionnaires and surveys. This content is then presented to patients, members, providers or other stakeholders electronically or through other means to gather responses. Jiva analyzes these responses to drive pre-determined actions based on client-specific clinical or business rules.

Clinical Protocols and Rule Packages
Jiva has clinical protocols for the major disease conditions built and maintained to industry standards. These protocols go beyond typical assessments by enabling clients to auto-generate care plans and drive activities based on responses. Clients can use these protocols, build upon them or create new ones as needed

Jiva offers several rules packages such as Auto Approval, Productivity, Clinical Disease Identification and Gaps in Care that run on the  SRE and enable clients to address specific business, clinical and regulatory requirements. These rules run in real-time,  allowing clients to respond immediately to problems and opportunities.

Multi-channel Communications
Jiva provides a comprehensive set of capabilities that enable members, patients, providers and care managers to communicate through multiple means of communication such as phone, mail, fax, email and portal based on their preferences.

Data Exchange Services
The Data Exchange Services include standardized interfaces with a diverse set of external systems including medical and pharmacy claims, lab and diagnostics, predictive modeling, decision support tools (such as Interqual and MCG care guidelines), fax and Google Maps. Jiva can exchange referral information via Web, Fax and EDI.

Portal Services
Jiva’s secure portal services enable clients to involve members, patients, physicians and other stakeholders in the care management based on their goals

  • For Providers
    Providers can log in to the portal and get a 360-degree view of a patient’s EHR, check eligibility across multiple payers, request and receive approvals of a referral or admission, view and collaborate with the care manager and patient on care plans, access decision support tools, submit appeals or grievances, complete surveys or questionnaires and run patient reports.
  • For Members
    Members can log in to the portal for a comprehensive view of their profiles, collaborate with the care manager and physician(s) on the care plan, complete assessments and surveys, access relevant educational material, receive alerts and notifications, and submit an appeal or grievance.
  • For Employers
    Our clients can enable employers and other customers to obtain relevant information on their members. Employers can log in to the portal to run reports on their member populations and submit referrals for care management.