Pharmacy services
We work with you to optimize outcomes and improve operational effectiveness
Health plans and PBMs can improve pharmacy management with our predictive and prescriptive analytics solutions, clinical quality and utilization management services, workflow technology, and prescription claim auditing capabilities.
We enhance pharmacy operations, enable digital transformation, and turn raw data into a strategic asset, providing powerful population health insights that let you stay competitive and achieve market growth and expansion.
Who we serve
We work with health plan and PBM clients in managing their pharmacy programs to empower pharmacy managers to focus on what matters most — improving member outcomes and quality, containing costs, and ensuring members and providers receive the best experience possible.
What we do
Pharmacy utilization management
Create efficiencies and accuracies across utilization management (UM) operations that drive cost containment and quality outcomes while enabling pharmacy resources to focus where needed most.
Pharmacy quality & care management
End-to-end care management services leverage HEDIS, STARS and Pay for Performance (P4P) quality measures to improve patient care and support customer's objectives in total cost of care reduction and delivery on contractual commitments.
Payment services
Control costs associated with incorrectly billed or overpaid pharmacy claims, focusing on prevention, avoidance, and recovery.
Effectively conduct analytics, contract, payment policy and fraud, waste and abuse reviews to drive appropriate utilization, behaviors and accountability.
Pharmacy operation and digital transformation
Optimize pharmacy operations and capacity support by embedding natural language processing (NLP), machine learning, conversational AI and robotics/automation into current workflows.
Population & risk analytics
Driven by client data, our advanced analytics provide a comprehensive member view and deliver actionable insights into opportunities to impact member health, quality and medical costs.
Market growth & expansion
Segment your market, identify and monitor trends, maximize enrollment and prioritize opportunities and invest accordingly.