Medical Cost and Care Quality for Health Plans

To thrive in the highly regulated, yet highly competitive health insurance marketplace, your health plan's ability to pay for the best possible clinical outcomes at the lowest possible cost is crucial. Our evidence-based clinical and financial support solutions can give your health plan the actionable information required to make coverage and payment decisions based on the appropriateness of care.

The foundation of our sophisticated utilization management portfolio is our criteria, which can provide your health plan on-demand access to the latest medical necessity support at every level of patient care, including precise information on genetic and molecular diagnostics. Our Intervention MessagingRx™ solution provides better access for member engagement through face-to-face pharmacy interventions and customized, real-time messaging with strategic objectives. We provide access to InterQual with a host of technology solutions that automate medical review and authorization, and work with a network of alliance partners to incorporate clinical decision support into their payer and provider solutions. We also enable health plans to better manage the explosion in number and cost of molecular diagnostics through DEX™ Diagnostics Exchange.

In today's health care environment, value tends to be your most sought-after goal. Our unique suite of medical cost and care quality solutions can help your health plan optimize utilization, reduce administrative costs, support better medical outcomes and enhance the patient experience.