Our Health Plan Services

You shouldn’t feel short-changed by your health plan

We’re the change that’s needed. Centivo health plans provide high-quality, affordable healthcare to employers and their employees and families.

 

Our health plan services include a custom-built network, benefit design, and integrated administration services. You can add a Centivo plan to your benefit options, replace your TPA or carrier with Centivo, or implement Centivo so it works with your existing health plan.

Locally optimized provider networks

A proprietary network of high-performing primary care providers

Centivo identifies the highest-value primary care providers to contract with, and compensates them with an enhanced fee schedule and incentives based on patient access and experience, as well as referral and prescribing patterns, so they, in turn, can provide excellent healthcare.

...and several methods that ensure market-competitive rates outside of primary care.

We form our specialist relationships through a variety of initiatives, including direct contracting, flexible PPO network rentals, wrap networks, and transparent or reference-based reimbursement. In addition, Centivo identifies and contracts with the highest quality specialized solutions, including Centers of Excellence, specialized providers, and online programs, for high-cost, high-risk conditions.

Unique Plan Design

A high-value plan design that incentivizes members to coordinate their care

Our unique value-based Partnership Plan is designed to encourage members to use high-value providers, access preventive and primary care, and manage chronic conditions. This keeps out-of-pocket costs low and predictable, giving our members financial peace of mind. Furthermore, we have the flexibility to adapt the plan design, or administer any other plan design, to meet each employer’s unique needs.

Partnership Plan - HPS
RX-Strategy
Flexible Rx strategy

Employers can use our preferred PBM partner to minimize waste and reduce their pharmacy costs, or bring their own

Pharmacy spend represents 20% of a typical employer’s healthcare costs. That figure is rising as new gene therapies and specialty pharmaceuticals are introduced. By working with Centivo’s transparent PBM partner, employers can often reduce pharmacy spend by 10-15%.

Accountable Administration

Working to root out inefficiencies and ensure our members receive the best care at the right cost

Claims Admin

Claims Administration

Centivo uses the highest level of financial and operational controls to ensure no money is wasted through errors or overpayment. This includes:

  • Fully-integrated technology, which enhances connectivity between claims processing, employer, member, and provider portals, and care management technology
  • Flexibility to accommodate value-based plan designs, bundled payments, prospective payments, and dynamic pricing
  • Scrutiny of high-dollar and specialized claims
  • Ongoing monitoring of new treatments, clinical standards, and coding and claims handling
Employer Portal
Reporting
Health Management
Your employees deserve a better health plan

Find out what Centivo can do for you and your employees

On the fence about replacing your health plan?

Bolster your existing health plan with Centivo. Learn more