Programs

We offer medical management programs designed to support our members at any stage of their health care journey. Our member programs are enhancements to our members’ total benefit package. They help our members lead healthier lives, and our programs reinforce and support your treatment plans.

Medical management

Our programs include case management, diabetes and disease management, palliative care, hypertension management, kidney health, laboratory, pharmacy, radiology, cardiology and physical and sleep medicine.

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Quality

When you share cost and quality data with our members—your patients—they can make more informed health care decisions. Learn about our Quality Program and read about best practices in our Quality in Action newsfeed.

Quality Program Quality in Action

Quality Incentive Program (QIP)

Medicare Advantage incentive programs

Earn incentives when you partner with us to improve health outcomes for our Medicare Advantage members.

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Commercial QIP

Earn incentives when you address and close care gaps for Individual on-exchange members. Learn about eligibility and payout, member attribution and gap closure.

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Risk adjustment

Risk adjustment encourages us to compete with other insurers on quality and efficiency, preserving consumer choice and improving quality of care. Risk scores are calculated differently for Medicare and commercial members, but both require the same types of information.

Member programs and tools

Our programs help members live healthier lives and are offered as enhancements to their total benefit package. Programs reinforce and support your treatment plans.