Health Plans
A clear path to greater control, savings and member experiences
From new government regulations to overpayments and member experience, health plans are tackling multiple challenges at any given time—and it’s costing them billions. That’s why it’s crucial for plans to curb costs—especially wasteful spending, which accounts for over 20% of total healthcare spend.
Solutions For Health Plans
Designed to address the growing needs—and costs—of health plans and their members.
By merging the value of traditional rebates, manufacturer copay cards and patient assistance programs into one streamlined discount, our solution is re-imagining the drug benefit – creating a win-win solution for pharma, payers and patients that will dramatically lower out of pocket costs for drugs and reduce medication drop off.
- 100% transparent - $0 spread
- 100% of the discount goes to the patient and payer
- Minimal transaction fees
- Faster client payments and data return
Our formulary management services ensure the delivery of optimal clinical care to patients while maximizing cost efficiency for plans, groups, and members. Leveraging our tools, services, and in-house P&T committee, we create clinically driven formularies that result in lower costs and improved outcomes.
We make optimizing and managing your pharmacy rebates simple. Our end-to-end rebate management services cut through the complexities of the landscape with ease and uncover the cost savings you have been missing.
- Biosimilar Strategies
- Medical Rebates
- Rebate Oversight & Management
- Therapy Class Carve-Out Rebates
We’re sharing the industry secrets other vendors won’t. With the goal of creating lasting systemic change and lowering healthcare costs for payers, we go beyond the standard claim review process. We’ll help you identify the root causes of errors to impact true fixes at the source.
- Payment Integrity Consulting
- Audit & Recovery
- Audit Management Technology
The increasing demand for expert health plan support in handling complex regulatory filing tasks calls for a dedicated partner—and it’s exactly where we excel. We’ll focus on your compliance success while you focus on your strategic growth.
- HCRA Support
- Qualified Health Plan Filing & Consulting
- RxDC Filing Assistance
We deliver the underwriting support you need to create a world-class stand-alone pharmacy benefit group contract. We’ll provide robust health plan consulting that addresses your key gaps and increases the number of lives carved into your plan.
One-stop, self-service SaaS platform to get payment accuracy right from the start. Our technology powers the entire payment integrity audit workflow from data ingestion through reporting.
ClearFile is an intelligent software-meets-service solution that simplifies the NAIC System for Electronic Rates and Forms Filings (SERFF) user interface. From automated, real-time access to state guidance updates, to a streamlined integration and dissemination of binder, form and rate filing deadlines and requirements, ClearFile ensures a seamless user interface for filing success.
We’re raising the bar for benefits in the workplace. We’re freeing employers and their people from unaffordable healthcare—delivering refreshing experiences and rewarding self-funded plans at a lower cost.
- Targeted savings solutions for Rx & specialty medications
- Dozens of ways for employees to save on healthcare
- Enhanced member benefits & experience
- Average 25% less cost than comparable plans
- Dedicated benefits experts/health advocates
- Streamlined access to financial assistance
With aggressive and innovative PBM contracts and targeted specialty savings solutions we help lower employer Rx spend up to 30%.
- Robust network of strong PBM contracts
- Unlocks negotiating power for groups of all sizes
- Pharmacy savings analysis
- Streamlined RFP process
- We negotiate and define Rx contract terms on your behalf
Best-in-class pharmacy benefit resources, clinical insights and savings through specialized Rx services that deliver the lowest possible pharmacy prices year after year.
- PBM Procurement
- Market Support
- Medical Rebates
- Injectables
- Pharmacy Data & Analytics
- Trend & Clinical Management
- PBM Pharmacy Audits
- Medical Variable Copay
We lower employer benefit spend by making it simple to save. Our one-stop-shop for seamless, human-to-human benefit-cost navigation helps groups and their people:
- Understand their benefits
- Choose high-quality, lower-cost treatment
- Reduce prescription costs
- Resolve billing issues
- Lower high-cost bills
- Easily access hospital financial assistance
While employers look to you for counsel on their benefits—look to us to cut through the noise.
We build, customize and deliver broker solutions that lower health and Rx costs, elevate employee and employer experiences—and keep your clients coming back year after year.
And we’ll take care of all the heavy lifting for you.
Featured
we’re building a better health plan
We’re raising the bar for benefits in the workplace. We’re freeing employers and their people from unaffordable healthcare—delivering refreshing experiences and rewarding self-funded plans at a lower cost.
Let’s Reinvent Healthcare, Together
We help health plans grow their business, while keeping member care, costs and experience at the center. We’re proving that industry stakeholders can do well while doing good at the same time.
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Understanding your needsWe start by understanding your unique challenges
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Customized Strategy DevelopmentOur team recommends tailored solutions that address your specific goals
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Seamless IntegrationWe work closely with you & your team to ensure smooth implementation
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Ongoing CollaborationAs your partner, we maintain regular communication and provide timely updates and insights, ensuring we continue to align with your evolving needs
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Performance Tracking & OptimizationWe monitor, measure and analyze the impact of our solutions - while keeping an eye on the market for new innovations that deliver the best possible results to your members
Let’s talk.
It’s time to maximize your team’s potential, lower costs and elevate your member experience.
Case Study
“Second Pass” Recovery Audit Returns $2.5MM to Medicare Advantage Plan
- Focus: Redefining Administrative Efficiency
We were engaged as the “second pass” auditor for a 47,000 member Medicare Advantage plan, behind a large, national healthcare analytics and recovery organization….
Break up with the status quo
We’re igniting real change. From building and accelerating revolutionary healthcare businesses to delivering transformative tech and services to our clients, we’re raising the bar of what healthcare can be.
Ready to join us?
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