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.

Cutting-edge technology and clinical expertise provide a total drug management solution that improves outcomes while maximizing savings. Our pharmacy benefit management (PBM) program is the 7th largest in the United States. We provide services tailored to the unique needs of your members and ensure medication adherence. Envolve’s PBM services include the following:

  • Comprehensive reporting options, including real-time client access to data
  • Formulary management
  • Home delivery services
  • 24/7/365 live customer service help, staffed with licensed pharmacy technicians
  • URAC Pharmacy Benefit Management Accreditation and NCQA Utilization Management Certification

Learn more about how our PBM program can work for you too.

The On.Demand Diabetes Management Program offered by Envolve delivers the right intervention at the right time while reducing waste and removing barriers to member engagement.

This program allows members to better manage their diabetes diagnosis through improving clinical outcomes and lowering costs. The On.Demand Diabetes Management program helps by:

  • Educating and aiding members in managing their diabetes in their home
  • Supplying kits that include program introduction, cellular glucometer, test strips, and how-to guides
  • Delivering monthly reports containing biometric readings, member engagement, and compliance levels
  • Managing interventions to boost compliance and drive behavior change

Historically, our Diabetes Management Program has delivered a 28% increase in compliance and a 6% decrease in members average glucose levels.

These metrics have helped achieve a 22% reduction in ER spend and 15% fewer ER visits per member per month. Learn more about the On.Demand Diabetes Management program.

Envolve proudly offers a 100% live-answer nurse advice line delivering an optimal experience while educating members on appropriate care and service levels. Our nurse advice line service is a 24/7/365 resource providing clinical support immediately from the comfort of home. The service features:

  • A single-call resolution model
  • Nurse triage teams across the country linked via HIPAA-compliant software systems
  • Multilingual accessibility, including:
    • 90% Bi-lingual non-clinical staff
    • 35% Bi-lingual clinical staff
    • Services provided in more than 200 languages via live interpretation
  • RNs licensed in all 50 states and Washington, D.C., Puerto Rico, and the U.S. Virgin Islands
  • Proven methods to get members to the right place the first time, reducing ER and other medical costs

Learn more about our Nurse Advice Line solutions.

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.

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