Powerful capabilities.
Proven expertise.
Exponential possibilities.

 

 

We help you find success in a complex healthcare system.

 

When we join forces, the opportunities are limitless

Better outcomes. Cost of care. The pace of innovation. What keeps you up at night keeps us up too — but for different reasons. With perspective gained from serving more than one in three people in the U.S., we know that this is challenging work. It’s what we do.

 

Through our flexible approach and industry-leading data, capabilities, and digital tools, we help health plans, employers, providers, government agencies, and pharmacies make their critically important work easier and more successful.

Behavioral health

Bringing parity to behavioral and physical health once and for all

 

We are ready to meet heightened demand for behavioral health support through a full range of clinical, administrative, and financial capabilities that manage risk in specialty populations. With a wide network of behavioral health providers, we deliver patient-centered care that integrates behavioral and physical health to address crises in mental wellness, recovery, and addiction.

 

Our behavioral health business Beacon Health Options

96%

in-network utilization

115,000

providers

40M

individuals served

Many communities aren’t built to handle behavioral health crises. A new infrastructure with scalable services is changing that.

Value-based care delivery

Providing specialized care for high-risk individuals with complex, chronic conditions or advanced-stage illnesses

 

We drive integrated, patient-centered whole health solutions for complex care journeys. Through a high-tech and high-touch multidisciplinary model that proactively manages risk and addresses social and behavioral health factors, we reduce hospital and inpatient admissions and bed days — while improving health outcomes and decreasing cost of care.

 

Our value-based care delivery businesses Aspire Health, CareMore Health

23%

fewer inpatient admissions

41%

fewer inpatient bed days

30-60

minutes for primary
care appointments

Related resources

Meeting the individual where they are, physically and clinically, with tireless compassion. That’s healthcare the way it should be.

Pharmacy

Reinventing pharmacy care for simple, seamless, and personalized experiences

 

We leverage our innovation, deep medical insights, and clinical expertise to drive pharmacy cost savings while providing personalized engagement and improving health outcomes. Through artificial intelligence and a deep data ecosystem, we can proactively close care gaps and improve medication adherence.

 

Our pharmacy business IngenioRx

3.6%

overall drug trend (medical + pharmacy)

7.1%

overall specialty drug
trend (medical + pharmacy)

40.5%

more adherent with medications

34.9%

care gaps closed

Ingenuity is at the heart of making the healthcare system work better for everyone. Learn why that quality is more essential than ever in pharmacy care.

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Digital platforms

Transforming the health ecosystem by connecting stakeholders through data-enabled digital tools

 

We make whole health possible by connecting the healthcare system with dynamic digital tools united under one platform and powered by our platform intelligence. With insights gained from an organization serving millions of people, we generate significant cost savings through automation of health operations, and insights that personalize care and improve health outcomes.

 

Our digital platforms business Carelon Digital Platforms

115M

insights based on 115 million people

Care pathways

Ensuring appropriate, safe, and affordable healthcare

 

Carelon works hard to make care effective, affordable, and accessible. Our specialty and post-acute medical benefits management solutions help providers to align care with proven best practices and helps members access that care in their community. From musculoskeletal care and cancer care to cardiology and home health, our evidence-based care pathways routinely improve outcomes while strengthening partnerships with key stakeholders, like providers and community-based organizations.

 

Our care pathways businesses AIM Specialty Health, myNEXUS

30-40%

of total health plan cost of care managed

90%+

provider satisfaction

 

~20%

reduction in hospital admissions

Better healthcare starts with best practices. Explore the five practices that leading health plans are adopting to make exceptional care the norm.

Related resources

Research

Delivering powerful insights to drive better health outcomes

 

Our unique combination of expertise, data, and relationships enables us to ask meaningful questions and arrive at more-informative and more-actionable answers. From prospective, observational, interventional, or retrospective research, our experience spans the healthcare spectrum. With decades of experience designing and carrying out a broad range of complex and meaningful studies, we generate evidence in healthcare to deliver better value and outcomes.

 

Our research business HealthCore

80M+

lives of robust data within its ecosystem

25+

years of experience

350

abstracts, posters, and manuscripts
published over the last three years

Operations and technology services

Improving health plans’ efficiency through digital and operational transformation

 

We provide value to health plans and reduce their costs through streamlined operations and automated, scalable services. From end-to-end operations management to individual services, like claims processing, cloud adoption, provider system management, analytics, and contact center operations, we help health plans operate more efficiently and raise customer satisfaction.

 

Our operations and technology services business Legato

11,000+

IT professionals, data scientists, and engineers

90%

contact center
customer satisfaction

12%

reduced cost of
claims operations

99.3%

batch job 
accuracy

Payment integrity

Accelerating accuracy to improve costs

 

We address fraud, waste, and abuse so that health plans can focus their resources more on achieving better whole health outcomes. For all lines of business, including Federal Employee Plans, we apply our unrivaled experience, rigorous data science, and advanced analytics to optimize each step of the payment value chain, with an emphasis on prevention rather than reaction. And we do all of this while delivering providers an exceptional experience and helpful education.

 

Our payment integrity business Meridian Resource Company

30+

years of experience
 

<1 year

average recovery cycle
time

$10.2B+

recovered in 2019

100

Net Promoter Score

Ready to learn more?

We’re here to answer any questions you have about our capabilities.