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.
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.
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.
EXL Health delivers intelligence to shape strategies that transform your business.
Human ingenuity is the catalyst with which we solve your complex problems.
6 OF THE TOP 10
US health plans partner with us
3 of the Top 5
PBMs partner with us
Gartner Peer Insights Customers’ Choice for Data and Analytics Service Providers, 2020*
KLAS Top Ranking, Risk Adjustment & Analytics, 2020
*The GARTNER PEER INSIGHTS CUSTOMERS’ CHOICE badge is a trademark and service mark of Gartner, Inc. and/or its affiliates and is used herein with permission. All rights reserved. Gartner Peer Insights Customers’ Choice constitute the subjective opinions of individual end-user reviews, ratings, and data applied against a documented methodology; they neither represent the views of, nor constitute an endorsement by, Gartner or its affiliates. Gartner, Gartner Peer Insights ‘Voice of the Customer’: Data and Analytics Service Providers, 22 September 2020, Peers