What we do
Delivering Clarity and Control to Self-Funded Plans
Step 1 — Unified Data Layer
Your single source of truth
Payers
Insurance companies and health plans that process claims and manage member benefits. This includes data on coverage, claims history, and payment information.
National health information networks
Health Information Exchanges (HIEs) that securely share clinical data between healthcare organizations. Includes medical records, lab results, and treatment history.
TPAs
Third-Party Administrators that handle claims processing and administrative services for self-funded health plans. Provides claims data, eligibility information, and utilization reports.
PBMs
Pharmacy Benefit Managers that manage prescription drug benefits for health plans. Includes medication utilization, drug costs, and pharmacy network data.
Providers
Healthcare providers including doctors, hospitals, clinics, and specialists. Includes clinical data from electronic health records, billing information, and treatment outcomes.
Wearable integrations
Health data from wearable devices like fitness trackers and smartwatches. Includes activity levels, heart rate, sleep patterns, and other biometric data.
Step 2 — Health Plan Intelligence Engine
Identifying opportunities and risks
High-cost claim drivers
Pinpoint the specific services and conditions driving your highest costs.
Leakage and saving opportunities
Identify where care is being delivered outside your network or at higher-cost facilities.
Pharmacy utilization inefficiencies
Spot opportunities to optimize medication management and reduce pharmacy spend.
Predictive risk trends
Forecast future costs based on current utilization patterns and member health status.
Preventable claims
Identify claims that could have been prevented with better care management.
Network and plan mismatch
Detect when members are using out-of-network providers unnecessarily.
Pricing anomalies
Flag unusual pricing patterns that may indicate billing errors or overcharges.
Step 3 — Optimization Recommendations
Clear strategies based on your data
Adjusting benefit design
Optimize your plan structure to better align with member needs and cost goals.
Redirecting site-of-care
Guide members to more cost-effective care settings without compromising quality.
Contracting with high-value providers
Identify and negotiate with providers who deliver better outcomes at lower costs.
Improving chronic condition management
Enhance care coordination for members with chronic conditions to prevent complications.
Structuring incentives
Design member and provider incentives that drive better health outcomes and cost efficiency.
Enhancing primary care access
Improve access to primary care to prevent costly emergency department visits and hospitalizations.
Step 4 — Member Tools that Drive Better Decisions
Transparency that empowers smart choices
Benefits
Clear visibility into what's covered and what's not, eliminating surprises.
Pricing
Transparent pricing information so members know costs before receiving care.
Coverage
Easy-to-understand coverage details and eligibility information.
Best-value providers
Recommendations for high-quality providers who deliver care at fair prices.
Personal recommendations
Personalized care recommendations based on individual health needs and history.
Preventive needs
Proactive reminders and recommendations for preventive care and screenings.
Step 5 — Continuous Improvement Loop
Building a long-term strategy
Monthly updates
Regular monthly insights keep you informed of trends and opportunities as they emerge.
Quarterly reviews
Comprehensive quarterly analyses provide deeper insights into plan performance and member health.
Annual strategy
Long-term annual planning helps you build a sustainable approach instead of waiting for renewal season.
The search for smart health decisions end here
Find the right health plan option for your needs.
Revolutionizing health with transparent pricing and actionable insights.