Health Plan Client Engagement

Consultative support for our health plan clients delivering strategic development, cost management solutions and regulatory and compliance expertise.

The health plan market is a rapidly changing environment. For those health plans that offer government programs, such as Medicare and Medicaid, this requires a great deal of expertise on the intricacies of regulatory and compliance operations. Other health plans may be looking at expanding into new markets, staying on top of the Exchange, or bringing new benefits into their offering – such as pharmacy (a "carve-in" approach).

The Health Plan Client Engagement team offers a consultative approach that delivers industry-leading cost management solutions supported by market insight, client-driven research studies, marketing solutions, and extensive support for regulatory and compliance programs.

We can help you fuel growth in your unique market, expanding your capabilities with our market expertise, infrastructure, resources and bid strategies.

In today's increasingly competitive market, what worked yesterday may not work tomorrow. We stay at the forefront of changes and how they may impact our clients' business strategies, bringing them proactive and actionable insights and solutions.

Medicare: Medicaid:
Our clients grow
3x
faster than the industryhttps://hmais.healthmanagement.com/reports/medicaid-managed-care-enrollment-for-300-plans-in-39-states-plus-ownership-and-for-profit-vs-not-for-profit-status-updated-sep-20/
Our clients make up nearly
50%
of all Medicaid beneficiaries
Exchange: Commercial:
Our Exchange lives grew by
33%
year over year
One client grew
29%
in one year
Medicare:
Our clients grow
3x
faster than the industry1
Medicaid:
Our clients make up nearly
50%
of all Medicaid beneficiaries
Exchange:
Our Exchange lives grew by
33%
year over year
Commercial:
One client grew
29%
in one year

Proven cost management strategies

Payors are facing growing pressure to deliver a robust, lower-cost pharmacy benefit. CVS Health has developed a wide range of strategies tailored to meet the needs of health plan clients and offer new ways to help reduce costs while continuing to provide high-quality care. Our formulary management expertise, innovative network strategies, and suite of utilization management solutions are designed to help clients better manage the leading drivers of pharmacy spend.

Resources to help clients succeed

CVS Health continues to invest in infrastructure to ensure flexibility in operations, adherence to stringent quality and compliance metrics, consultative support for all lines of business, and the ability to adapt programs to meet clients' business goals. Government Services teams are highly engaged with regulators at the federal and state levels to provide insights on the changing health care landscape, as well as discussing solutions that can benefit both payors and their members. Our teams are active participants in the Pharmacy Quality Alliance and National Committee for Quality Assurance.

Have a question on how we can support your health plan? Ask Us

Data source, unless noted otherwise, CVS Health Enterprise Analytics, 2021.

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