Skip to content 
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.
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.
Flexible Rx strategy
Employers can use our preferred PBM partners 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 partners, employers can often reduce pharmacy spend by 10-20%.
Accountable Administration
Working to root out inefficiencies and ensure our members receive the best care at the right cost
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
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 Administrative Portal
Our administrative portal allows employers and their brokers or consultants to securely access a wide range of financial, administrative, and clinical information for health plan management.
Reporting & Analytics
Our powerful analytics and reporting dashboard is a key aspect of our administration package. We partner with a leading analytics company to offer employers insight into their healthcare spend. The fully integrated analytics suite offers:
- Current state and predictive analytics
- Commercial and Medicare benchmarking
- Near real-time data integration, including eligibility, medical and pharmacy claims, lab and biometric, vision and dental, and Health Risk Assessment (HRA) data — with reports and drill-down analyses
- Multiple Care Gap measures (NCQA HEDIS, ACO, PQRS, APH)
Population Health Management
Centivo provides ongoing population health management to identify and treat conditions early, avoiding future complications, as well as to help manage the most severe and costly cases. Members with gaps in care and early signs of chronic disease are identified daily based on medical and pharmacy claims, and then offered programs through concierge outreach. Centivo’s integrated technology enables seamless patient management across all touchpoints, including concierge and disease management interactions.
How It Works
The Centivo Experience
Penelope, 52, was recently diagnosed with diabetes.
Over the years, she’s changed health plans and doctors many times. No one doctor has the full picture on her health. With a family history of cardiovascular disease, Penelope is keen to stay ahead of any new conditions.
Someone like Penelope could end up having:
- Poor coordination between doctors, leading to conflicting advice and medications
- ER visit stemming from uncontrolled diabetes and cardiovascular disease
- Duplication of tests
- Avoidable surgery
- Unrecognized (and therefore untreated) depression
…Resulting in large medical and pharmacy costs and absenteeism
Getting started with the Partnership Plan
Once annual enrollment ends, Penelope receives an email from Centivo confirming that she’s enrolled.
Shortly before the plan year begins, Penelope receives her ID card and a hard copy welcome kit, prompting her to activate online.
Penelope forgot to activate, so she receives email reminders, and then a follow-up call and letter if needed.
Selecting a Primary Care Team
To activate, Penelope downloads the Centivo app and creates her account.
When she logs on, Penelope is prompted to designate a primary care doctor using the recommendation tool for herself and each of her dependents.
The primary care practice receives a list of the members that have designated their doctors to lead their care, so they can welcome the members to their practice.
Coordinating Specialist Care
Penelope hasn’t been feeling well and decides to check in with her primary care doctor.
Her doctor determines he’d like her to see a cardiologist. The doctor or his team use the Referral Management Tool in their Plan Portal to identify top specialists for Penelope and initiates the referral.
Coordinating Specialist Care – Part 2
After the visit, Penelope receives a confirmation of the cardiologist referral in her app.
Penelope goes in for her specialist visit and presents her ID card from her app, which clearly states her referral copay, and pays the copay before leaving the office.
The PCP manages her referral in the Centivo Provider Portal to close the loop with Penelope and her specialist.
How It Works
The Centivo Experience
Penelope, 52, was recently diagnosed with diabetes.
Over the years, she’s changed health plans and doctors many times. No one doctor has the full picture on her health. With a family history of cardiovascular disease, Penelope is keen to stay ahead of any new conditions.
Someone like Penelope could end up having:
- Poor coordination between doctors, leading to conflicting advice and medications
- ER visit stemming from uncontrolled diabetes and cardiovascular disease
- Duplication of tests
- Avoidable surgery
- Unrecognized (and therefore untreated) depression
…Resulting in large medical and pharmacy costs and absenteeism
Getting started with the Partnership Plan
Once annual enrollment ends, Penelope receives an email from Centivo confirming that she’s enrolled.
Shortly before the plan year begins, Penelope receives her ID card and a hard copy welcome kit, prompting her to activate online.
Penelope forgot to activate, so she receives email reminders, and then a follow-up call and letter if needed.
Selecting a Primary Care Team
To activate, Penelope downloads the Centivo app and creates her account.
When she logs on, Penelope is prompted to designate a primary care doctor using the recommendation tool for herself and each of her dependents.
The primary care practice receives a list of the members that have designated their doctors to lead their care, so they can welcome the members to their practice.
Coordinating Specialist Care
Penelope hasn’t been feeling well and decides to check in with her primary care doctor.
Her doctor determines he’d like her to see a cardiologist. The doctor or his team use the Referral Management Tool in their Plan Portal to identify top specialists for Penelope and initiates the referral.
Coordinating Specialist Care – Part 2
After the visit, Penelope receives a confirmation of the cardiologist referral in her app.
Penelope goes in for her specialist visit and presents her ID card from her app, which clearly states her referral copay, and pays the copay before leaving the office.
The PCP manages her referral in the Centivo Provider Portal to close the loop with Penelope and her specialist.
