The gap care managers can't close

Oct 7, 2025

Care gaps

Care management is finally getting the investment it deserves.

Health systems are hiring more care managers, building better workflows, and investing in platforms that help them identify high-risk members and coordinate interventions. Value-based contracts are making outcomes matter, and leadership is paying attention.

But there's still a gap.

A care manager can write a brilliant plan for a member with uncontrolled diabetes. She can explain exactly what needs to happen: schedule the endo appointment, start the medication, check glucose daily, log meals. She can even call to follow up.

But she's got 200 other members. And there aren't enough hours in the day.

So what actually happens? Some members follow through. Most don't. A few might do one thing but not the others. And the care manager doesn't know which is which until the next hospitalization or the next A1C result three months later.

The gap isn't the plan. It's the 47 things that have to happen between writing it down and the member actually doing it.

This is where Edwin comes in.

Edwin scales what your best care managers already do—turning their guidance into personalized missions that meet members in whatever channel they actually use, adapt when obstacles show up, and verify what happened.

  • Every care plan becomes a sequence of concrete, achievable actions tailored to how this member actually lives

  • Prompts and check-ins adjust based on what's working and what isn't

  • Verification closes the loop: your care team sees exactly what got done, what didn't, and why

From care plan to outcomes.

Together, your care management platform and Edwin create the full chain:

Risk stratification → Care plan → Edwin → Verified action → Documented outcomes → Better care

Why this matters now.

As value-based care grows, "we reached out to the member" isn't enough anymore. You need proof of completion. You need to show that the member scheduled the specialist, picked up the prescription, and started checking their glucose. Edwin gives you that data—not as a nice-to-have, but as the foundation for improving outcomes and proving impact.

Beyond traditional care management.

The same engine that scales your care managers works across the continuum:

  • Post-discharge: Making sure members actually fill prescriptions and attend follow-ups

  • Chronic care programs: Driving consistent behavior change for diabetes, hypertension, and obesity

  • Population health: Closing care gaps at scale without overwhelming your team

  • Social determinants: Connecting members to resources and verifying they got there

The future of care management isn't more calls. It's closing the loop between what you recommend and what actually happens. Edwin is how you get there.