Find avoidable cost and act on it.
Our market proven AI-driven models, implemented within Blue plans, combine clinical, utilization, claims, and operational data to surface high-value intervention opportunities. Those insights are built directly into business workflows, so teams can act on them.
ResultApproximately 4% year-over-year medical expense improvement in targeted areas.
Why it matters
Costs outrun premiums
US health spending grew 7.5% in 2023 and is projected to keep growing faster than the economy. Every year a plan waits, the medical loss ratio gets harder to hold.
Waste sits between teams
Duplicate and inaccurate payments, missed coordination of benefits and out-of-network leakage fall between departments, so no single report shows them.
Findings have to reach the workflow
An opportunity that stays in a report is rarely acted on. It needs to show up where the team already works.
US health spending keeps rising
US health spending has grown faster than the economy for years, and CMS expects that to continue. That curve is what every plan's medical budget sits on.
Source: CMS Office of the Actuary, National Health Expenditure data (2023) and projections (2024-2033). 2024 and 2025 are CMS estimates; 2033 is the CMS projection under current law.
How we work
Baseline the spend
Clinical, utilization, claims and operational data, broken down to where each dollar starts.
Choose what moves first
Opportunities sized by value and effort, agreed with your finance and medical leaders.
Act and measure
Insights built into the business workflow, and every improvement tracked against the agreed baseline.
What the work covers
- Payment integrity and claims accuracy review
- Coordination of benefits and subrogation
- Network and contract performance
- Site-of-care and utilization patterns
- Pharmacy spend review
- Intervention opportunities built into workflows
Common questions
Have a question that is not here?
Ask our teamWhat is medical expense reduction?
Lowering what a plan pays for care without lowering its quality: paying claims accurately, guiding care to the right setting, and contracting with providers who deliver good outcomes at a fair price.
How is this different from cost cutting?
Cuts that move cost onto members or providers come back as complaints, appeals and lost members. We look for avoidable spend, and remove that.
Do you work with the vendors we already have?
Yes. Most plans already use payment integrity and analytics vendors. We work with them and cover the gaps between them.
How are savings measured?
Against a baseline agreed before the work starts, using a method your finance team signs off.
Related services
Measurable P&L impact. Every time.
Across medical expense, administrative cost, and risk-adjusted revenue, our focus is the same: AI must translate into financial results, not just another pilot or technology deployment.
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