Expert Human Intelligence

Goodbye, Doctor Referrals.
We’ve Got a Better Way.

Guided by our Clinical Advisory Board of world-class physicians, we are pioneering the
process of defining doctor quality at the condition level.

VIEW OUR EXPERTS

A MEDICAL DIAGNOSIS CAN BE SCARY

Recently diagnosed? Now what?

When someone is facing a diagnosis that threatens their quality of life, it may feel overwhelming and confusing. They want the assurance that their physician has proven expertise with your condition and accepts their insurance. And, they aren’t sure exactly where to start.

QualityCare ConnectSM gives them much more than the names of physicians. We add value, a personal touch, by ensuring the optimal patient-physician match leveraging evidence-based data science and the expertise of our experienced healthcare team and world-renowned Clinical Advisory Board.

CLINICAL INSIGHT WITH A HUMAN TOUCH

We know which doctor to see.

No matter the diagnosis, we know the best way to find a good doctor for our members. We leverage our clinical human navigators’ expertise in selecting and matching physician profiles. Having identified the optimal area of expertise for each condition, we find physicians who are leaders in their fields.

Whether its for a routine checkup, initial specialist referral, or getting a second opinion, our Care Navigation team provides the heartbeat to our business and personalized advocacy whenever patients need it.

“Getting the right patient to the right doctor the first time is a critical aspect of healthcare today.”

Iain H. Kalfas, MD
Head of Spinal Surgery, Department of Neurosurgery, Cleveland Clinic
Member of ArmadaHealth’s Clinical Advisory Board

IMPROVING HEALTHCARE OUTCOMES

How exactly do we define quality?

Defining quality in healthcare is no easy task. Fortunately, we have a team of physician experts on our side, and they help us determine the right clinical focus areas for each condition. They also identify our target metrics and help us ask the hard questions, like:

How many procedures performed per year are acceptable for us to recommend a surgeon for pancreatic cancer?

What is an acceptable complication rate for hip replacement procedures?

What kind of specialist should we recommend for gestational diabetes?

To answer these questions, we start with evidence-based clinical outcomes to define healthcare quality. Next, we leverage large volumes of data to determine qualifications and highlight relevant experience.

We can narrow the field of physicians to identify the ones of highest quality with the help of :

Published evidence-based guidelines
Internal and external subject matter experts
Our Clinical Advisory Board

Together, we define and maintain definitions of healthcare quality at the primary, specialty, subspecialty and condition level, which we then translate into ontologies and algorithms on our data science platform.

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SPECIAL ADVISORS

James D’Orta, MD

The Honorable David J. Shulkin, MD

CLINICAL ADVISORY BOARD

Benjamin Safirstein, MD

EXECUTIVE DIRECTOR OF CLINICAL ADVISORY BOARD

Mary K. Thomas, MD

MEDICAL DIRECTOR

David L. Helfet, MD

CHIEF OF COMBINED ORTHOPAEDIC TRAUMA, HOSPITAL FOR SPECIAL SURGERY/NEW YORK PRESBYTERIAN HOSPITAL

Kelly Hunt, MD

PROFESSOR AND CHAIR, DEPARTMENT OF BREAST SURGICAL ONCOLOGY, THE UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER

Iain H. Kalfas, MD

HEAD OF SPINAL SURGERY, DEPARTMENT OF NEUROSURGERY, CLEVELAND CLINIC

Scott J. Swanson, MD

DIRECTOR OF MINIMALLY INVASIVE THORACIC SURGERY, BRIGHAM AND WOMEN’S HOSPITAL

Andrew Tucker, MD

MEDICAL DIRECTOR, SPORTS MEDICINE, MEDSTAR UNION MEMORIAL

SPECIALTY CHIEF CONTRIBUTORS

James Aisenberg, MD

CLINICAL PROFESSOR OF MEDICINE, THE MOUNT SINAI HOSPITAL

Louis M. Aledort, MD

DEPARTMENT OF MEDICINE – HEMATOLOGY, MT. SINAI HOSPITAL

Elise Michele Brett, MD

ASSOCIATE ATTENDING, THE MOUNT SINAI HOSPITAL

Eugene F. Foley, MD

PROFESSOR AND CHIEF, DIVISION OF COLORECTAL SURGERY

Roy G. Geronemus, MD

DIRECTOR OF THE LASER & SKIN SURGERY CENTER OF NEW YORK

Simon J. Hall, MD

ZUCKER PROFESSOR OF UROLOGY, THE SMITH INSTITUTE FOR UROLOGY, HOFSTRA NORTH SHORE – LIJ, SCHOOL OF MEDICINE

Michael Kaliner, MD

INSTITUTE FOR ASTHMA & ALLERGY, P.C., RESEARCH AND EDUCATION CENTER

William S. Krimsky, MD

DIRECTOR, CENTER FOR INTERVENTIONAL PULMONOLOGY, MEDSTAR FRANKLIN SQUARE MEDICAL CENTER

C. Ronald MacKenzie, MD

ATTENDING PHYSICIAN, DEPARTMENT OF RHEUMATOLOGY, HOSPITAL FOR SPECIAL SURGERY

Christopher Magovern, MD

CARDIAC SURGEON, GAGNON CARDIOVASCULAR INSTITUTE, MORRISTOWN MEMORIAL HOSPITAL

Paul N. Manson, MD

PROFESSOR, DEPARTMENT OF SURGERY, THE JOHNS HOPKINS UNIVERSITY

Bryan F. Meyers, MD, MPH

CHIEF, THORACIC SURGERY, DIVISION OF CARDIOTHORACIC SURGERY, PATRICK AND JOY WILLIAMSON PROFESSOR OF SURGERY, WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

Geeta Nagpal, MD

ASSISTANT PROFESSOR OF ANESTHESIOLOGY, NORTHWESTERN MEMORIAL HOSPITAL

Joseph V. Nally Jr., MD

DIRECTOR OF THE CENTER FOR CHRONIC KIDNEY DISEASE, CLEVELAND CLINIC

John E. Robinton, MD

CHIEF CLINICAL OFFICER, AUTHENTIC 4D

Mark L. Urken, MD

DIRECTOR OF HEAD AND NECK SURGERY, MT. SINAI BETH ISRAEL MEDICAL CENTER

Willis Wagner, MD

CLINICAL CHIEF – DIVISION OF VASCULAR SURGERY, CEDARS-SINAI MEDICAL CENTER

Robert Zager, MD

MEDICAL DIRECTOR, HUMC MOUNTAINSIDE HOSPITAL CANCER CENTER

See how Navigation-as-a-Service improves your member experience and enables you to drive down costs.

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