Health Plans
Integrated healthcare performance programs for health plans
Choose offerings aligned to your cost, quality, and member experience priorities. We quantify savings and opportunity, activate targeted interventions, and track performance through ongoing governance.
HITRUST certified
HIPAA compliant
AICPA SOC
100% U.S.-based
95%+
3rd-party audit accuracy
2,500+
Providers supported
500+
Practices across 13+ states
100%
U.S.-based expert teams
VALUE DELIVERED
Key outcomes for health plans
Each program drives measurable, defensible improvement across risk, quality, and cost.
RAF score accuracy
Auditable HCC capture with compliant documentation and reduced RADV audit exposure.
Stars & HEDIS improvement
CDI-driven gap alerts at point of care with >50% improvement in targeted STAR metrics.
Total cost reduction
Site-of-care redirection and pharmacy optimization driving net spend down.
DEPLOYMENT MODEL
A proven 3-phase engagement
We quantify savings and opportunity, activate targeted interventions, and track performance through ongoing governance.
01 — Discover
Set scope & baseline
Quantify opportunity
02 — Commit
MSA signed, launch SOWs
Finalize agreements
03 — Deliver + Scale
Operate, iterate, expand
Govern and grow
Offerings
Choose the programs that fit your priorities
Each module can be activated independently or in combination under a single master agreement.
Risk Adjustment & CDI
Accurate, auditable HCC capture with compliant documentation.
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At-visit alerts
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Prospective & concurrent review
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Rx HCC support (Part D)
Value delivered
RAF score accuracy
Audit mitigation
Compliant documentation capture
Provider education & engagement
Quality & Stars
CDI-driven prompts plus evidence capture to lift Stars scores.
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Stars/HEDIS gaps by provider
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Point-of-care alerts to address gaps
Value delivered
Increased provider engagement
Point-of-care measure surfacing
Improved gap closure rates
Actionable quality gaps
Site-of-Care & Referral Management
Reduce facility-fee exposure and shift referrals in-network.
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HOPD to ASC, office, home redirection
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Preferred routes: infusion, imaging, ortho
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Leakage analytics plus referral tracing
Value delivered
Facility-administered medication management
Total cost of care reduction
Pharmacy Cost Management
Comprehensive Drug Interchange & Formulary Alignment.
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At-visit alerts
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Prospective & concurrent review
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Rx HCC support (Part D)
Value delivered
Reduce pharmacy drug costs
Enhance prescriber decision-making
Rebate Strategy
Standalone rebate offering for medical drug spend.
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Contract analysis & optimization
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Market intelligence benchmarking
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Revenue recovery tracking
Value delivered
Formulary & rebate strategy alignment
Patient Engagement & Outreach
End-to-end patient engagement and outreach for healthcare entities.
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Driving appointment adherence
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Closing care and risk gaps
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Improving documentation accuracy
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Streamlining practice workflows
Value delivered
Enhanced quality performance
Improved reimbursement accuracy
Easier, more efficient operations