Care Management Platforms for Payers – Provider Compendium 2025

The shift toward value-based care, proactive population health management, and quality-linked reimbursement models is rapidly transforming the healthcare industry. Care management platforms have become foundational infrastructure, enabling organizations to manage chronic conditions, close care gaps, enhance regulatory reporting, and improve member outcomes.

Recent advances have extended platform capabilities beyond documentation to include AI-enabled orchestration, real-time analytics, and interoperability frameworks that integrate Electronic Health Records (EHRs), claims, labs, pharmacy data, social determinants of health, and wearables. Providers are increasingly embedding generative AI for care plan automation, conversational engagement, and clinical record summarization, while agentic AI is beginning to assist in decision-making areas such as prior authorization.

Despite these innovations, challenges persist in achieving seamless EHR integration, end-to-end workflow automation, and consistent adoption of next-generation features. Consequently, buyers are emphasizing platforms that offer scalability, automation, user-centric design, and interoperability with other systems. Providers, in turn, are differentiating through domain-focused capabilities (for example, chronic disease management and behavioral health), star optimization, and interoperability maturity.

This report evaluates care management platform providers, positioning them as Leaders, Major Contenders, and Aspirants based on their vision, capabilities, and market impact. The analysis leverages Everest Group’s annual RFI process, provider briefings, buyer interviews, and proprietary market research.