Six services. One retention outcome.

Exemption Engine

The Exemption Engine continuously scans ADT feeds, EHR problem lists, behavioral health encounters, and claims to identify members who qualify for a work requirement exemption — before the county sends a renewal notice.

How it works

1. 01Ingests ADT admission and discharge alerts in near real-time.
2. 02Parses EHR problem lists and encounter diagnoses for exemption-qualifying conditions (SUD, SMI, medically frail, pregnancy, and more).
3. 03Cross-references claims history for inpatient stays, residential treatment, and chronic condition management.
4. 04Scores each member with a confidence level (Confirmed / Likely / Possible) and surfaces the supporting evidence.
5. 05Generates a pre-populated exemption packet ready for care manager review and county submission.

Retention Navigators

Retention Navigators are trained community health workers and enrollment specialists who reach out to members flagged by the Exemption Engine. They help members understand their options, gather documentation, and complete the renewal process.

How it works

1. 01Navigators receive a daily work queue prioritized by renewal urgency and exemption confidence score.
2. 02Each outreach attempt is logged against the member record, with outcome codes that feed back into the platform.
3. 03Navigators guide members through self-attestation for DV/trafficking, homelessness, and caregiver exemptions.
4. 04For members without a clear exemption, navigators help document qualifying work, volunteer, or education hours.
5. 05Warm handoffs to care managers, social workers, or county eligibility workers when escalation is needed.

Work Hours Record

For members who don't qualify for an exemption, the Work Hours Record provides a structured, mobile-friendly way to log and submit 80 hours of qualifying monthly activity — including gig work, informal caregiving, and volunteer hours that are hard to document through traditional payroll records.

How it works

1. 01Members log hours through a simple mobile interface — no app download required.
2. 02Supports gig platforms (Uber, DoorDash, Instacart), informal employment, and self-employment with attestation.
3. 03Volunteer and education hours are tracked with organization name and supervisor contact for verification.
4. 04Monthly summaries are automatically formatted to meet DHCS reporting requirements.
5. 05Alerts fire when a member is at risk of falling below 80 hours before the monthly deadline.

Contact Refresh

Contact Refresh continuously reconciles member contact information across plan records, county data, and clinical systems — so renewal notices, navigator outreach, and exemption packets reach the right address, phone number, and email.

How it works

1. 01Compares plan contact records against county eligibility data, EHR demographics, and ADT discharge addresses.
2. 02Flags discrepancies and surfaces the most recently verified contact information.
3. 03Identifies members with no valid mailing address — a leading predictor of renewal failure.
4. 04Integrates with navigator outreach so updated contact information is used immediately.
5. 05Tracks contact refresh outcomes to measure address accuracy over time.

Coverage Shield

Coverage Shield monitors the renewal pipeline for members at risk of disenrollment and triggers escalation workflows when a member is approaching a coverage gap — giving plans, clinics, and counties a last line of defense before coverage is terminated.

How it works

1. 01Monitors county renewal status feeds for members approaching the termination threshold.
2. 02Triggers escalation alerts when a member has not completed renewal documentation within 30 days of the deadline.
3. 03Surfaces any new clinical signals that may support a late exemption claim.
4. 04Coordinates with navigators for emergency outreach and same-day documentation support.
5. 05Logs all escalation attempts and outcomes for plan compliance reporting.

Retention Analytics

Retention Analytics gives health plans, public health systems, and counties a real-time view of their retention pipeline — from exemption detection rates to navigator outreach outcomes to post-renewal coverage continuity.

How it works

1. 01Real-time dashboard showing exemption detection rate, outreach completion rate, and renewal success rate by population segment.
2. 02Cohort analysis by exemption category, geography, language, and care complexity.
3. 03Trend reporting to identify emerging risk populations before renewal waves hit.
4. 04DHCS-formatted compliance reports for plan reporting requirements.
5. 05Exportable member-level data for integration with existing quality and care management systems.