Experience Matters

Go deeper for better solutions.

We help health plans across the country identify opportunities to gain more value across their entire operations. Our comprehensive data solutions go deeper to address the biggest problems the healthcare industry — and you — faces.

View by Line of Business:


National Commercial Plan

$1.75 PMPM ER cost savings across entire population

~3% reduction in ER visits

$15.60 PMPM ER cost savings of diabetics over 45 years of age
Telehealth utilization increases of 566 visits per 1k member per year

Regional Blue Plan

Ability to measure clinical programs with efficiency and accuracy to drive cost-saving insights

Regional Blue Plan

ER visits declined by 8.1% and costs by $8 PMPM; Avoidable ER visits decreased by 5.1% and $0.35 PMPM

National Commercial Plan
Medicare Advantage Line of Business

33% increase in enrollment over baseline for behavioral health diabetes program

55% increase in enrollment for behavioral app program

Behavioral health cost trend reduced 176%

Regional Blue Plan

8x increase in speed to evaluate clinical program portfolio

50+ programs directed at Total Cost of Care measured in 6 months, identifying 15 programs with statistically significant results driving $70M in savings


Regional Blue Plan

Uncovered CHF program working ($143 PMPM cost reductions) but was spiking MSK spend ($39 PMPM). NHT helped spark shift in Care Manager scripts and deployed an MSK predictive model to steer members to in-network physicians and to Blue Distinction Center, leading to $42 PMPM reduction in MSK costs in targeted trial population over 6-months.

Medicare Advantage

Outbound outreach: ~0.44 more gaps closed PMPY

Inbound outreach: ~0.42 more gaps closed PMPY 

Medicare Advantage

Reduced ER visits 87.13 visits per 1k members per year

$327k in visit-based savings over 4 ½  months driven by trial group

$9 PMPM savings from avoidable ER visits


National Medicaid

20-50 fewer preterm deliveries

1,000 enrolled moms and 20-40 fewer low birth weight babies per 1,000 enrolled moms

Regional Medicaid

25% reduction in avoidable ER visits

39% reduction in ED costs in targeted population (identified through prediction of high likelihood of avoidable ED visits)

26% reduction in ED utilization in targeted population (identified through prediction of high likelihood of avoidable ED visits)

Regional Medicaid

6.3% reduction in ER visits; $6 PMPM reduction resulting from member outreach

Insights and additional resources for measurable change.

Executive Advisory Council

The NextHealth Technologies Executive Advisory Council (EAC) is an invitation-only think tank of healthcare’s most innovative minds. Senior executives from regional and national health plans, representing approximately 65 percent of the U.S. population, and integrated delivery systems meet quarterly in a collaborative, small-group setting to discuss how to impact healthcare affordability and member satisfaction.

Download our meeting summaries

Health Equity

At NextHealth, we have been providing insight to influence behaviors since our inception. Our experience enables payors to address disparities in health status “from the cradle to the grave” with a focus on three determinants factors:

  1. Access to care and services
  2. Activation, engagement and education
  3. Patient-centered outcomes

Are you looking for a partner to help you amp up your impact on health inequity? Read more in our blog post and let’s talk about how we can tackle this big problem together, for our members and their families.

COVID-19 Resources

Strategies from leading health plans on combating COVID-19 

3 Key Strategies During COVID-19

Our customer base represents over 30% of covered lives in the U.S. We assembled a group of executives from our partner health plans to create a forum around critical health care topics. Recently we met to discuss COVID-19 and how the health plans are responding to and preparing for the broad impact of the crisis.

The Broader Impact of COVID-19

Three health care experts from NextHealth dive into what questions payers are asking about the future of the pandemic. Discover how NextHealth has updated configurations in the platform to combat COVID-19 and the future trends they are seeing with virtual care practices.

Case Studies

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