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
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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 artificial intelligence and an unparalleled dataset. With insights gained from an organization serving 115 million 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
2,800+
clinical algorithms
Care pathways
Ensuring appropriate, safe, and affordable healthcare
Carelon works hard to make care effective, affordable, and accessible. Our specialty and post-acute care pathways 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.
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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
17+
years and ~80M+ lives of robust data within its ecosystem
25+
years of experience
350
abstracts, posters, and manuscripts
published over the last three years
Preterm birth is the leading cause of illness and death in newborns. Luckily, there’s recent evidence that we can reduce its prevalence affordably. Learn more.
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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.
