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 has never been more important. 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 InterQual clinical care guidelines, 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. We provide access to InterQual with a host of technology solutions that automate medical review, authorization, notification and eligibility, and offer immediate access to coverage, network rules, medical appropriateness and in-network service provider information.

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