Best care management software for IPAs and ACOs in 2026.

How to choose care management software

The best care management software for a risk-bearing IPA or ACO is the one that turns hospital and emergency-department events into action while the follow-up window is still open. Two questions separate the field. First, does the tool ingest real-time ADT feeds (admission, discharge, and transfer events) and turn them into transitions-of-care worklists? Second, does it close the loop by running the outreach, or does it stop at documenting a care plan for your staff to work?

That distinction matters because the clock is short. CMS transitional care management (TCM) requires an interactive contact with the member or caregiver within two business days of discharge, and a face-to-face visit within 7 or 14 days depending on complexity. The NCQA HEDIS Transitions of Care (TRC) measure rewards four documented steps within 30 days of discharge: notification of admission, receipt of discharge information, medication reconciliation, and patient engagement. Software that finds out about a hospitalization weeks later from a claim cannot hit those windows. For the mechanics of turning feeds into action, see our deep dive on transitions of care and ADT automation.

1. Real-time ADT, not retrospective claims

Ask where the admission and discharge signal comes from and how fresh it is. A tool wired to live ADT feeds through an HIE or notification network sees the event the day it happens and can start the two-day TCM contact clock. A tool that infers the hospitalization from a claim is structurally weeks late. Real-time ADT is the difference between a transitions-of-care program that hits the window and one that documents misses after the fact.

2. Documents the plan, or runs the outreach

This is the dividing line. Most care management platforms document: they hold assessments, care plans, and tasks, and they surface a worklist for nurses and coordinators. Closing the loop is a different job. It means reaching the member, completing the medication reconciliation, booking the follow-up visit, and capturing the result. A useful test: ask what happens after the system flags a discharge. If the answer ends at a task on a coordinator's queue, that is documentation. If the platform places the call and updates the record, that is closing the loop.

3. One outreach queue across teams

In a risk-bearing organization the same member often sits on a transitions-of-care list, a quality gap list, and a pharmacy adherence list at the same time. When each team runs its own queue, the member gets called three times and the coordinators duplicate work. A single canonical record per member, with one shared outreach queue, lets one contact handle the discharge follow-up, the open care gap, and the medication question together. The trade-off is depth in a single program versus coordination across all of them.

4. Audit posture and compliance

For risk-bearing and payer-grade work you still need a defensible audit trail on every automated action, a signed Business Associate Agreement, and tenant-isolated data handling. Confirm full audit logging on any outreach the software places on your behalf, especially when a voice agent or computer-use agent acts inside an EHR or payer portal.

What changed in 2026

Three things moved this year that belong in a care management shortlist.

CMS started paying for chronic care that happens between visits. The CMMI ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) pays for technology-enabled chronic care against measurable outcomes rather than per service. It runs four tracks: early cardio-kidney-metabolic, cardio-kidney-metabolic, musculoskeletal pain, and behavioral health. Cohort 1 began July 1, 2026, and CMS selected roughly 150 participants (STAT, April 13, 2026). If a payment model settles on whether the follow-through happened, the difference between a documented care plan and a completed contact stops being philosophical.

Transitions of Care becomes an ECDS measure in measurement year 2029. NCQA is retiring the hybrid method by MY 2029, and TRC is one of the measures moving to Electronic Clinical Data Systems reporting that year, alongside Glycemic Status Assessment and Care for Older Adults (NCQA). The same post states NCQA's goal of fully digital HEDIS by MY 2030, with measures shipped as computable specifications in HL7 FHIR and CQL, not a PDF a vendor reads and codes. Practically: a chart chase will not carry TRC much longer, and the structured documentation your ADT workflow produces now is the rehearsal.

Every vendor now says it closes the loop. League's Spring '26 release (March 3, 2026) put a Care Gaps Agent Team in the market that checks coverage and provider availability and books appointments directly. Linear Health sells a similar loop to FQHCs and clinic networks, stating up to 90% of coordination work automated and first patient contact in about five minutes. Those are real products. So stop treating "execution layer" as a label and use it as a test. Four questions settle it:

• Which channel, and who operates it. Phone, SMS, portal, pharmacy, in-home. For each one, ask whether the vendor's system places the contact or your coordinator does.
• ADT-triggered outreach latency. Innovaccer named this as one of its six care management criteria in June 2026, and it is the right axis. Measure the hours from the discharge event landing to the first contact attempt, not the days to a finished care plan.
• Where the evidence is written back. A completed medication reconciliation that lives only in the vendor's own workspace does not help you at TRC reporting or in an audit. Ask which system of record receives it, and when.
• One shared queue or one per program. Cross-payer gap consolidation is the plain version of this: if risk, quality, pharmacy, and care management each run their own list, the same member gets called three times in a week and each team thinks it did its job.

Arcadia surveyed 281 healthcare leaders in March 2026 and found 14% say AI insights are fully integrated into the decisions that matter, with embedding AI into workflows the most-cited barrier at 31% (Arcadia, June 16, 2026). That is a data-platform vendor publishing the workflow gap. It is the clearest reason to make a vendor demonstrate the four answers above rather than describe them.

Vendor comparison

The table groups representative vendors by what they are built to do. Categories are descriptive, not pejorative: a population-health analytics platform, a payer case-management system, and an execution layer solve different problems, and many risk-bearing organizations run more than one.

Innovaccer

Innovaccer is strong at population-health data unification. Its platform normalizes claims, clinical, medication, and real-time ADT data into one place, then layers care management and AI agents on top, with published work on transitional care management protocols and readmission reduction. Care management arrives as a module: Innovaccer launched a Care Management Copilot plus AI Agents on April 22, 2025, including an ED follow-up agent, and states a 28% reduction in documentation time and a 20% engagement lift. Its 2026 Best in KLAS recognition came in data and analytics for providers, data analytics for payers, and CRM, not in care management, where the 2026 award went to Cognizant TriZetto. Its own care management comparison, published June 10, 2026, argues for packaged workflows across the active CMS models (LEAD, ACCESS, TEAM, GUIDE) and states first-cohort ACCESS participation. Model coverage is a real advantage and worth weighing. It tells you which contracts a platform understands. It does not tell you whether the two-business-day contact after discharge happened. Those are different systems. (Sources: Innovaccer care management copilots; 2026 Best in KLAS winners.)

Arcadia

Arcadia runs a healthcare data lakehouse, curating EHR, claims, pharmacy, and ADT data into one longitudinal record, with real-time ADT event tracking through a notification-network partnership. Timely ADT is exactly what transitions-of-care work depends on, so that foundation matters here. At its Aggregate 2025 conference on October 27, 2025, Arcadia announced AI-enabled care management: a prioritization engine, predictive workload balancing across case managers, configurable mental-health workflows, intervention feedback loops, and a Medication History for Populations that includes cash-pay fills. Nordic Capital took a majority stake in the company on July 2, 2025. Arcadia fits when the priority is a clean, queryable data foundation with a well-ordered queue on top. Deciding who gets called first and placing the call are still two jobs, and Arcadia is built for the first. (Source: Arcadia, October 27, 2025.)

ZeOmega (Jiva)

ZeOmega's Jiva platform is a payer-grade care, case, and utilization management system. It pairs configurable workflows with clinical content and care pathways, automates care transitions, and coordinates stakeholders around next-best-actions, including support for dual-eligible Special Needs Plans. Jiva was named number one in Best in KLAS for payer care management four years running through February 2025; the 2026 award in that category went to Cognizant TriZetto. For a health plan or delegated entity that needs deep, configurable case management with strong clinical content, Jiva remains a strong fit. Its strength is structuring and coordinating the clinical work. The calls and visits are completed by your clinicians. (Sources: ZeOmega, 2025; Cognizant, 2026.)

Cognizant TriZetto (CareAdvance Enterprise, formerly Casenet)

The TriZetto CareAdvance solution, which came to Cognizant through Casenet, automates case, disease, and utilization management tasks that traditionally required manual nursing labor, and pre-integrates with TriZetto core systems for real-time data exchange. It automates member identification, care planning, task management, and monitoring at health-plan scale, with a CareAdvance Essentials tier for plans under 250,000 members. CareAdvance Enterprise took the 2026 Best in KLAS award for Payer Care Management, ending a four-year run by ZeOmega. For a health plan that wants case management tightly coupled to its core administration system, it is a proven enterprise option. It organizes and tracks the work well. Who actually picks up the phone is a separate question, and CareAdvance does not answer it.

Pearl Health

Pearl Health is built for ACO and provider enablement in Medicare risk models. Its AI prioritizes the highest-urgency patients and surfaces a focused set of high-impact opportunities across MSSP and ACO REACH populations. It has also moved toward doing the work: its 2026 product pillars are Performance Intelligence and Care Orchestration, the latter automating annual wellness visit scheduling and post-discharge follow-up. On July 8, 2026 Pearl raised $110M, $50M in equity led by a16z with Viking Global, AlleyCorp, and Ulysses Capital, plus $60M in debt from Trinity Capital, reporting 10,000+ providers, 40 states, 250,000+ beneficiaries, and profitability since 2025. For a primary-care ACO, Pearl is a serious option and no longer a purely analytical one. It works through the practices it enables, which leaves the rest of the teams inside a risk-bearing IPA out of its reach. (Source: MedCity News, July 2026.)

Reveleer

Reveleer is better known for chart retrieval and quality abstraction, and it entered this category by acquisition. Novillus, acquired April 22, 2025, brought care gap management and provider engagement; Curation Health, acquired October 8, 2024, brought 1,400 clinical rules and EHR integrations with Epic, Cerner, and Athenahealth. On April 7, 2026 it launched a Clinical Data Repository billed as a unified, AI-enriched member-level clinical record spanning risk adjustment, quality, RADV response, and care management, citing 1.2B+ pages of clinical data annually for 55+ health plans. If your care management problem is that nobody can see the member's full clinical picture, that is the right shape of answer. It is a record, not a coordinator. (Source: Reveleer, April 7, 2026.)

Health Catalyst

Health Catalyst pairs a large healthcare data platform with population-health analytics, predictive risk stratification, and a care management suite, strengthened by its acquisition of Upfront Healthcare in January 2025. For a system that wants analytics-first population health with care management modules and strong data integration, it is well established. Buyers should also weigh the company's current state, which is public record: Ben Albert became CEO on February 12, 2026, the company disclosed a restructuring on April 24, 2026 that included roughly a 9% workforce reduction, it agreed on June 4, 2026 to divest Vitalware for $147M, and its FY2026 revenue guidance of $260M to $265M is below FY2025. Ask about roadmap continuity for the care management modules specifically. As with other analytics platforms, its design point is computing risk and surfacing the intervention. Reaching the member sits with your teams.

Where an AI execution layer fits

The vendors above are strong at what they were built for, and most risk-bearing organizations need a solid data foundation and structured case management. The gap they feel is rarely a missing dashboard. With transitions of care, knowing about the discharge and completing the follow-up are two different jobs, and the second is where coordinator time disappears, especially when the same member is also open on a quality list and a pharmacy list.

Here are our answers to the four questions above, so you can hold us to the same standard. Channel: outbound voice agents place the call, and a live coordinator takes over on escalation. Latency: the transitions-of-care worklist is generated from the ADT event itself, so the clock starts the day the discharge lands, not weeks later when the claim arrives. Evidence: the completed contact, the medication reconciliation, and the booked visit are written back to the canonical record and to the source system the measure is reported from. Queue: one outreach queue shared across risk, quality, pharmacy, and care management, which is the only way cross-payer gap consolidation turns into one call instead of three.

Pelica is the execution layer. One canonical record per member, built from claims, EHR, pharmacy, lab, ADT, and payer feeds, sits under a Care Management copilot. Real-time ADT events become a transitions-of-care worklist automatically. The action layer then drafts and places the follow-up: outbound voice agents call the member, complete the medication reconciliation prompts, and book the visit, escalating to a live coordinator only when a human is truly needed. The copilot tracks the 5-day window so nothing ages out, and it keeps one outreach queue across risk, quality, pharmacy, and care management, so no member is called three times. The point is not to document the plan. It is to run it.

At our flagship customer, a physician-led IPA in New York running risk on roughly 175,000 patients, the Care Management copilot closed 70%+ of transitions-of-care gaps within 30 days and completed 7-day follow-up after 75% of emergency-department visits, while the platform reached 100% team adoption. Those numbers come from running the outreach on a real ADT feed, not from a tidier dashboard.

In transitions of care, the care plan is not the deliverable. The completed follow-up, inside the window, is.

None of this makes population-health platforms or case-management systems wrong. If you have no clean data foundation or no structured case-management workflow, you may need one first. But if your team already knows which members were just discharged and the follow-up is not getting done inside the window at volume, an execution layer is the purchase that moves the readmission and TRC numbers, and it deploys in weeks. For the broader market, see our head-to-head on the best value-based care software, our value-based care software buyer's guide, our take on member outreach automation, and the Pelica Care Management overview.

Sources

• CMS Medicare Learning Network: Transitional Care Management Services (MLN908628)
• NCQA: Transitions of Care (TRC) HEDIS measure
• NCQA: timeline for retiring and replacing HEDIS hybrid measures (TRC to ECDS in MY 2029; fully digital HEDIS by MY 2030)
• CMS Innovation Center: ACCESS Model
• STAT: CMS selects roughly 150 participants for ACCESS cohort 1 (April 13, 2026)
• Arcadia: 2026 healthcare AI survey, 281 leaders (June 16, 2026)
• HIT Consultant: full list of 2026 Best in KLAS winners