Member intelligence now.
Predictive forecasting next.
SMARTOps is the demand and supply intelligence platform purpose-built for government-sponsored health plans. It starts by helping you understand member behavior today, and grows into predicting the demand and staffing your operation will face tomorrow.
SMARTInsights, shown with demo plan data
One platform. Three modules. Built in sequence.
Each module solves a distinct part of the demand problem, and each builds on the one before it. We are shipping the foundation first, then layering forecasting and real-time response on top.
SMARTInsights
Understand who your members are and what drives their contact volume, by segment, cohort, and propensity.
Available NowSMARTForecast
Predict member demand and the staffing supply to meet it, with scenario planning and market intelligence.
In Development, Target Q4 2026SMARTAssist
Detect volume spikes in real time, trace them to a cause, and alert the functions about to feel the impact.
Planned, 2027Know your members before they call.
SMARTInsights turns years of de-identified plan data into a clear picture of member behavior, so you can see which cohorts drive volume and why, long before it shows up in your service levels.
- Member segmentation and cohorts. Break membership down by age band, plan design, geography, tenure, and line of business.
- Behavioral drivers and propensity. See which variables correlate most with call volume, and which cohorts are most likely to contact you.
- Built for the functions where demand actually lands. Telesales and Member Services are live today, Grievance and Appeals is close behind, and Enrollment, Billing, Claims, and Utilization Management follow on the roadmap.
SMARTInsights capabilities, shown with demo plan data
Predict the demand, and the staffing to meet it.
SMARTForecast takes the behavioral picture from SMARTInsights and projects it forward, modeling both the member demand you will face and the workforce you will need to meet it, up to 18 months out.
In development · Target Q4 2026Catch the spike as it happens.
SMARTAssist is the real-time layer. It watches live operational signals for the volume spikes that forecasting cannot anticipate, so your team learns about a surge while there is still time to respond.
Planned, 2027Designed for the realities of government-sponsored plans.
Minimal PII needed to start
SMARTInsights works from de-identified, aggregated flat files spanning five to six years. You can start with data you already extract for reporting.
Built by operators
Designed by people who ran health-plan operations and lived the cost of a missed forecast, not a generic workforce tool retrofitted to healthcare.
Regulation aware
Built around CMS rules, enrollment windows, and the regulatory calendar that reshapes demand for Medicare, Medicaid, and ACA plans.
Connected to the market
Forecasting layers in third-party actuarial and market-exit data, so projections reflect the wider market, not just your own history.
Not another workforce management tool.
Generic staffing software starts and ends with historical aggregated volume and ratios. SMARTOps starts from member behavior and the competitive and regulatory forces that move it.
Purpose-built for the segment
Designed specifically for Medicare Advantage, Part D, Managed Medicaid, and ACA operations and their partners.
Demand and supply, together
Models the volume you will face and the staffing to meet it, instead of projecting headcount from last year's averages.
Operator-built and CMS-aware
Shaped by people who lived these operations, and built around the regulatory calendar that drives them.
Up to 18 months out
Forecast member demand and staffing supply up to 18 months ahead, with built-in scenario planning and macro intelligence signals.
Stop staffing for the average. Start staffing for what is coming.
SMARTInsights is available now, with forecasting and real-time response close behind.