Flexible healthcare management solutions built around you.

Health Plan & Payer Solutions Designed To Reduce Costs & Improve Member Health

Whether you’re leading a Medicaid, Medicare, Exchange, or commercial health plan, the Envolve family of companies will help you analyze the needs of your members, so you can provide quality, cost-effective care that’s right for them.
 

Why Partner With Envolve?

We’ll help you meet your financial and health outcome goals by providing tailored strategies, support, and flexible benefit management solutions to your organization. Envolve, through our family of companies, offers the following featured solutions for health plans & payers ensuring members get the best care possible:

Our specialty pharmacy provides care management services that focus on members with complex conditions, bringing a personal touch to specialty drug management. We understand that when patients and physicians have the proper resources to create and follow a unique treatment plan, health outcomes improve and costs go down. That’s why our specialty pharmacy program includes:

  • Integrated pharmacy and medical specialty drug management, including claims processing, utilization management, prior authorization, retail, and 340B networks
  • State-of-the-art technology and analytics, including real-time data analysis and reporting
  • IV and injectable drug therapy training
  • The 9th largest specialty pharmacy network in the U.S.
  • Proven medication adherence programs, including monitoring and support
  • URAC Specialty Pharmacy Accreditation

Learn more about why so many trust the Specialty Pharmacy solutions offered by Envolve.

Our eye care services integrate evidence-based medicine and best practices to decrease exam and diagnostic claim costs. We can work with you to develop a flexible, customized vision plan best suited to you. Our vision solutions for health plans & payers include:

  • Routine and medical eye care coverage
  • Board-certified ophthalmologists, optometrists, medical directors, and staff
  • Extensive network of independent providers and popular retail chains across the U.S., including Puerto Rico
  • NCQA Certification in Utilization Management/Credentialing
  • Innovative HEDIS/Star rating enhancement services
  • Performance guarantees

Learn more about vision solutions offered by Envolve.

 

We offer comprehensive dental care through customized programs to deliver positive member outcomes and reduce administrative burden. Envolve is dedicated to improving oral health by delivering superior benefits like:

  • Innovative education and outreach programs
  • Individualized provider support
  • High-quality dental services
  • Cost-effective dental care management through a network of dental providers

Learn more about our URAC Health Utilization Management accredited dental care solutions.

 

Our healthcare management services organization (MSO) solutions enable better, more efficient healthcare through best-in-class business administration services, data utilization, clinical excellence, and operational support. Just a few highlights of our services include:

  • Innovative benefit designs to improve member health and comply with state/federal laws
  • A claims processing/payment engine providing accurate adjudication for complex plans and multiple reimbursement models
  • Two datacenters to secure core applications and data with redundant networking systems and backups
  • Production applications backed up daily to off-site storage facility that complies with HIPAA and HITECH rules

Learn more about our MSO Solutions.

Contact Us

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