Payers (Health Plans, Medicare Advantage, Commercial Insurers)

PharmD Live supports payers with clinical operations—CCM, RPM, TCM, medication programs, risk capture—to manage membership, reduce cost, and improve quality.

Payers (Health Plans, Medicare Advantage, Commercial Insurers)

Clinical Enablement for Payers & Health Plans

PharmD Live supports payers with clinical operations—CCM, RPM, TCM, medication programs, risk capture—to manage membership, reduce cost, and improve quality.

Clinical Enablement for Payers & Health Plans

Payers need to manage risk, control cost, and deliver quality to stakeholders. We become your clinical care management arm, delivering member-centric programs across their network. We support risk stratification, clinical oversight, care coordination, and medication expertise so you meet your value-based goals.

Challenges & Stat

Payers lose revenue and face high medical loss ratio due to avoidable hospitalizations. Medication nonadherence alone accounts for $100–300B in avoidable costs annually.

Solutions Offered

  • Chronic Care Management (CCM) + RPM
  • Transitions of Care Management (TCM)
  • Medication Optimization / MTM
  • HCC Risk Capture & Documentation
  • VBC Complete™ (payers coupling with provider networks)

Quality Measures We Improve

  • Star Ratings (medication adherence, readmission)
  • HEDIS (chronic condition control, preventive care)
  • Utilization metrics (inpatient, ED, readmissions)
  • CAHPS / member satisfaction
  • Risk adjustment / RAF scores

Challenges & Stat

Solutions Offered

Quality Measures We Improve

Why Payers Partner with Us

We provide a turnkey clinical operations engine across provider networks. With our pharmacist-led care, analytics, and coordinated execution, payers can reduce MLR, improve member outcomes, and elevate plan competitiveness.