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Flexible healthcare management solutions built around you.

Health Plan & Payer Solutions that Improve Health Outcomes and Reduce Costs

Envolve offers benefit management solutions including specialty pharmacyPBMvision and dental

With more than 30 years of experience serving a variety of payer types including Medicaid, Medicare, commercial and provider-led health plans, we understand that you are continually challenged to improve the health of your members while maintaining – or reducing costs.

Partnering with the Envolve family of companies allows for better healthcare and efficiency in delivery of care for health plans through services in business administration, effective data utilization, clinical excellence and operational support. With a focus on quality and actionable data, we can help you boost Star ratings and increase HEDIS scores. Our proven results and clinical efficiencies help you meet financial targets and margin expectations and provide best-in-class care to your members.  

We believe in total solution integration of physical health, behavioral health, total pharmacy management and ancillary services. Working together, our health plan solutions help you minimize costs, improve membership growth and satisfaction, deliver a strong provider network, and benefit from innovative technology solutions – through one simple, flexible partnership.

With some of our clients, we have entered into delegated risk arrangements for a variety of services representing a subset of the total insurance plan that they manage. Doing this allows health plans to operate with budget predictability by deferring the risk premium to Envolve.

Learn more about all our services below and contact us to find how they can be tailored for your needs.

By delivering benefits to the members of our health plan clients in a highly coordinated manner, our service capabilities and  partnership approach provide comprehensive, whole-health management to ensure that the best possible outcomes are delivered efficiently and effectively though information-based coordinated care. We employ proven, multi-faceted processes and approaches to engage, incentivize and collaborate with our health plan clients in the continual delivery of high quality, cost-effective care and with members to assist their access to needed services and supports. 

Members are our core focus. We are your partner in achieving efficient and effective assessment, diagnosis, care planning, treatment implementation and outcomes evaluation. Our member engagement approach is to “meet members where they are” by being culturally appropriate, person-centered and accessible to all individuals. Our goal is to ensure health plan members have the information they need to make informed choices about their health and healthcare. Through clinical expertise, integrated care and superior service, we help health plans improve member outcomes and manage risks.

Envolve’s comprehensive, flexible sourcing model helps health plans simplify their operations and achieve cost control. A key component of our quality health plan solutions is a network filled with caring, exceptional providers. We find that the ability to attract and retain quality network providers remains a key to our success. Using both financial and non-financial incentives to demonstrate our commitment and to reward providers for improving quality of care, we have identified innovative ways to broaden the scope of providers eligible for enhanced payments and to relate the incentives to HEDIS measures.

Partnering with Envolve gives you access to economies of scale, which allow us to serve our shared members through innovative and efficient mechanisms. We are a data driven organization focused on continuous quality improvement and individualized and flexible solutions. Identification and implementation of innovative programs to improve outcomes and promote cost savings and cost avoidance is a core function. As your back-office partner, we are an extension of your team and will help you achieve positive outcomes.

Through preventive outreach, members receive the satisfaction of a better quality life and the knowledge needed to make positive choices for their health. Through care gap closure, our health plan solutions provide the care members need while keeping costs in line. Envolve’s extensive and coordinated resources serve members with a marked-level of efficiency and our cost savings are consistently demonstrated across the health plans we serve. 

Our sophisticated data analytics platform continuously provides the data needed to ensure health plan members get the care they need, where and when they need it. Our award-winning informatics suite increases collaborative communication, data sharing, and reporting for payer operations and providers to improve the quality and continuity of care. It empowers the use of the latest enrollment and eligibility, health assessments, demographic data, and lab test results to identify patient risk and needed healthcare services. By incorporating medical, behavioral and pharmacy claims, our data can help manage costs and use of services.

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