Clinical Solutions

for Health Plans

Deliver on your promise of better care

In an era of increased spending and greater utilization of specialty care, our clinical solutions stand above the rest. Led by physicians and deployed through our industry-leading technology and operations, our clinical solutions span the most complex, costly specialties and deliver value by driving evidence-based care. As a result, they help you fulfill your mission of providing your members access to quality care.

A comprehensive approach to evidence-based care and affordability

We use a multifaceted approach to help assure your members access to appropriate, safe, and affordable care. Our solutions also provide data-rich insights on program performance and practice trends so you can power your strategies and manage your networks.

  • CLINICAL APPROPRIATENESS REVIEW
  • PROVIDER OUTREACH
  • MEMBER ENGAGEMENT
  • PEER-TO-PEER CONSULTATIONS
  • REDIRECTION OF CARE TO HIGH-VALUE SETTINGS
  • PROGRAM PERFORMANCE AND PRACTICE TRENDS REPORTING

Explore our clinical solutions

Musculoskeletal Solution

Genetic Testing Solution

Medical Oncology Solution

Radiation Oncology Solution

Sleep Solution

Cardiology Solution

Radiology Solution

Rehabilitation Solution

Our capabilities, your advantages

Our core capabilities fuel your transformation into a resilient, agile organization dedicated to its members’ health.

Aligning care with best practices: clinical appropriateness review

Helping physicians keep up with the latest best practices in evidence-based care is complex. We use our clinical guidelines, physician-led outreach, and innovation to make it easier. It’s our best practice.

Realizing the value of value-based reimbursement

The new value-based healthcare environment demands a proven platform engineered to support plans and providers. Meet ours.

Navigating the new health care landscape

The path to long-term success for health plans involves savings, quality improvements, and closer alignment with members and providers. We can pave that path.