Anoteros brought such strong expertise in health plans and the GuidingCare product — I didn’t even know there were consultants who could do that”
— Director of Care Management

Our client, a nonprofit Medicaid insurance provider serving over 400,000 members, approached Anoteros with significant operational challenges with its care management systems and processes. The organization’s Care Management and Care Coordination teams were struggling with complicated processes that prevented them from fully utilizing the capabilities of their care management system, HealthEdge®’s GuidingCare® care management platform.
The Care Management team was burdened by over 50 workflows that lacked standardization and were cumbersome to navigate. This complexity forced staff to document patient interactions outside the system and later transfer information, creating duplicative work and inefficiencies. Documentation primarily consisted of free-text notes, resulting in high variability and difficulty tracking outcomes through structured data collection. These limitations also hampered reporting capabilities needed to drive improved productivity and quality of care.
Additionally, with NCQA accreditation as a strategic goal, the client needed to ensure their operational processes met accreditation requirements while establishing a solid foundation for compliance

Drawing on our extensive knowledge of GuidingCare® functionality and care management best practices, the Anoteros team began with a comprehensive end-to-end review of all existing workflows, state contracts, and supporting documentation. During the Discovery phase of the project, we analyzed the information provided by the client to identify efficiency opportunities and system capabilities that could support more streamlined processes.
Our analysis also focused on identifying improvements needed to achieve NCQA accreditation and ensure compliance with relevant federal and state regulations. Working collaboratively with the client, we documented and reviewed suggested process changes and completed the system configuration necessary to implement previously unused
functionality. These enhancements added structure to workflows, improved guidance for staff, and created simplified methods for collecting member information in a structured format.
The Anoteros team developed comprehensive desk-level procedures and supporting materials that not only guided the client through implementing the new workflows but also served as valuable training resources for both current and incoming staff. We conducted comprehensive testing alongside the client to ensure the system performed as expected and met end-user requirements.
We shared industry best practices for post-implementation system management and established processes for the submission, review, and implementation of user-requested changes. To support a successful launch, our team assisted in configuration promotion between the lower and production environments and provided monitoring after go-live to ensure users had the knowledge and tools needed for their daily activities under the new workflow system.

The Care Management optimization transformed how the client’s teams operated. By consolidating over fifty workflows into just sixteen, we dramatically simplified how staff carried out their daily activities. Clinical staff gained the ability to improve documentation practices through structured data entry, reducing their reliance on lengthy narrative notes and improving the speed and efficiency of documenting member interactions and outcomes.
These improved practices significantly increased standardization in care management processes, enhancing the organization’s ability to report on outcomes and staff productivity while monitoring quality of care. The structured approach also positioned the client for greater success in achieving NCQA accreditation by aligning workflows with industry best practices.
Ultimately, the partnership between Anoteros and the client resulted in more efficient operations, better documentation, improved reporting capabilities, and enhanced care management for the 400,000 members served by this Medicaid insurance provider. By optimizing their GuidingCare® platform and associated workflows, Anoteros helped the client build a stronger foundation for continued growth and improved member services.