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Health Plans

Better health outcomes and increased member ratings, all while reducing costly claims​.

Improving member health while controlling costs can be a daunting balancing act. QualityCare ConnectSM was designed to help organizations accomplish both of these without sacrificing member health or organizational goals.

Our service uses a proprietary data science approach to match individuals with the ideal in-network physician based on their area of clinical expertise and the individual’s specific health condition.

We create a frictionless path for physician referrals, so that the largest drivers of cost, misdiagnosis and unnecessary treatments, are minimized. We do the heavy lifting, so you can benefit from streamlined healthcare and a product offering that stands out.

QualityCare Navigator

Give call center agents the tool they need to identify ideal doctors for members based on more than 30 quality factors. Learn how QualityCare Navigator can improve clinical navigations . . . and your bottom line.

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How health plans benefit from
QualityCare Connect

Reduces the Leading Drivers of Cost

Misdiagnosis and unneeded appointments, test and procedures are high up on the list of healthcare cost drivers

Enhances Member Engagement and Quality Ratings

Boost HEDIS, CMS Star Ratings and Core Quality Measures by facilitating optimal access to the right physicians with a personalized experience

Minimizes Costly Claims

Tackling claims cost ensures bottom line security

Differentiates Product Offerings

With a crowded marketplace, it’s paramount to offer plan features with unique appeal

Improves Effectiveness of Health Management Tools

Better healthcare outcomes provide a win-win for member and health plan while improving Medicare Star ratings

Optimizes Resources via a Plug-in Solution

Optimize your network, care coordinators and consumer experience – let us facilitate your referrals

Download our valuable resources, including the Navigation-as-a-Service eBook, and learn how your organization can improve clinical navigations for better member experience and lower costs.

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MAKING BETTER CHOICES

The importance of choosing the right physician

Hear from our clinical advisors on the power of better healthcare choices.

Requirements for a Good Medical Referral

What Makes a Doctor the Best in Their Field

Get the tools you need to get started.

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