Payers

We assist payers in tackling rising medical costs while improving care quality.

We offer expertise in:

• medical cost management
• payment integrity
• network design and contracting
• care model innovation
• quality-program optimization
• pharmacy cost management
• intelligent automation and digital solutions

We help payers reduce administrative burdens, boost efficiency, and enhance member and provider experience.

We offer expertise in:

• end-to-end AI enablement and workflow automation
• operations optimization across the value chain
• process redesign and workflow digitization
• operational performance management and analytics
• vendor management and outsourcing optimization

We help craft tailored growth and performance improvement strategies for the needs of specific segments.

We offer expertise in:

• product design and portfolio innovation
• pricing sophistication
• risk accuracy
• salesforce effectiveness and marketing
• distribution channels and broker engagement
• regulatory compliance

We help payers create, launch, and scale new businesses and M&A capabilities to support enterprise growth.

We offer expertise in:

• pharmacy strategy
• diversified provider and payer services
• ancillary benefits
• M&A target identification and outreach, including prediligence, enterprise strategy, and agile resource planning

We help improve organizational performance and health outcomes by strengthening member experience and engagement.

We offer expertise in:

• consumer attraction and retention
• patient- and member-centric engagement strategies
• consumer experience enhancements
• consumer insights and analytics

We help payers strengthen core technologies and apply next-gen AI to drive meaningful performance gains.

We offer expertise in:

• technology-enabled operating models
• agentic-AI-embedded workflows and domain rewiring
• enterprise analytics strategy
• global tech talent and efficiency
• core technology architectures, from cloud to platform hosting

Our cloud-based, HITRUST-certified data analytics platform helps healthcare payers connect data, uncover insights, and improve performance:

• Comprehensive datasets: closed claims data covering ~220 million lives
• Core reference sources: clinical risk segmentation models; national provider affiliation data; county-level enrollment; service-line growth forecasts; and demographic projections
• Applications: modules for value analytics, population health stratification, competitive intelligence, and growth analytics to enable faster, data-driven decision-making

Our proprietary databases and benchmarking tools help payers measure performance, identify improvement opportunities, and benchmark success against peers:

• Medical policy database and clinical rules engine: automated, structured database with policies built from comprehensive medical and clinical guidelines
• Site-of-care optimization tools: rapidly identify opportunities to shift care to more cost-efficient settings across infusions, minor surgical procedures, imaging, lab, and more
• Medical spend benchmarking: taxonomy-driven benchmarks to evaluate medical cost performance relative to peers

Our tools help healthcare payers translate technology into sustained business impact:

• Technology evaluation framework: rapid assessments of existing platforms with clear improvement roadmaps
• AI for Data Quality (AI4DQ): interoperable AI and machine learning modules to enhance data quality pipelines and workflows
• Agents@Scale: vendor-agnostic platform for defining, orchestrating, and deploying AI agents via low- or no-code approaches
• GAIL: interoperable modules for common gen AI application patterns, deployed through containerized microservices