Clinical programs

Informed, compassionate support when your employees need it most

When an employee has an accident or a child who's seriously ill, managing health systems and insurance policies feels impossible to navigate. Deciphering coverage and calculating costs can become overwhelming.

We know how stressful this time can be. In response, we offer a team of health experts ready to help your members navigate complex systems and get the care they need. They can easily integrate with additional clinical programs you offer to plan members.

Critical support at a critical time

Our registered nurses, health coaches, and case managers are here to respond to questions, develop care plans, support physician treatment plans, identify potential obstacles, and provide in-network solutions for medical and behavioral health care. These individuals are knowledgeable and compassionate, whether offering support for members and caregivers or working with their entire health team to coordinate care.

Delivering cost-effective care

Our utilization management program uses evidence-based decision-support criteria to help ensure plan members receive medically-appropriate care for their condition covered under their plan. Utilization and case management work in tandem to help increase patient compliance, predict and manage costs, and improve the effectiveness of medical treatment plans.

Integrated medical and pharmacy

An integrated pharmacy and medical strategy provide more meaningful value for you. Real-time analysis of medical and pharmacy data ensures more effective outreach, which leads to better care decisions. With a seamless employee experience and simplified plan administration, we bring you an integrated approach that better supports employee health and lowers health care costs over time.

Extra support for a healthier pregnancy

A well-managed pregnancy is a great way to help mom and baby get a healthy start on life together and manage overall health care costs. Our maternity management program is designed to help expecting members successfully manage their health before, during, and after the baby is born.

Learn more about our other areas of expertise

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Custom network management

Your members, business, and goals are unique. Our custom approach reflects it.

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Flexible plan design

Our experts help you choose the services, solutions, and packages that best fit your needs.

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Analytics and reporting

Get the deep, customizable insights necessary for your plan management and strategy.

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