Our experts, clinicians, and data specialists partner with healthcare payers, including commercial insurers, ACA individual insurers, Medicaid, and Medicare organizations, to build more efficient, technology-enabled enterprises that improve care quality, reduce costs, and create better experiences for members and providers alike.
HOW WE CAN HELP
Total medical cost and quality transformation
We assist payers in tackling rising medical costs while improving care quality.
We offer expertise in:
- medical cost management
- payment integrity
- network design and contracting
- care model innovation
- quality-program optimization
- pharmacy cost management
- intelligent automation and digital solutions
Operational efficiency and effectiveness
We help payers reduce administrative burdens, boost efficiency, and enhance member and provider experience.
We offer expertise in:
- end-to-end AI enablement and workflow automation
- operations optimization across the value chain
- process redesign and workflow digitization
- operational performance management and analytics
- vendor management and outsourcing optimization
Business-specific sustainable growth strategies
We help craft tailored growth and performance improvement strategies for the needs of specific segments.
We offer expertise in:
- product design and portfolio innovation
- pricing sophistication
- risk accuracy
- salesforce effectiveness and marketing
- distribution channels and broker engagement
- regulatory compliance
Diversified businesses and inorganic growth
We help payers create, launch, and scale new businesses and M&A capabilities to support enterprise growth.
We offer expertise in:
- pharmacy strategy
- diversified provider and payer services
- ancillary benefits
- M&A target identification and outreach, including prediligence, enterprise strategy, and agile resource planning
Consumer strategies
We help improve organizational performance and health outcomes by strengthening member experience and engagement.
We offer expertise in:
- consumer attraction and retention
- patient- and member-centric engagement strategies
- consumer experience enhancements
- consumer insights and analytics
Core technologies and AI adoption
We help payers strengthen core technologies and apply next-gen AI to drive meaningful performance gains.
We offer expertise in:
- technology-enabled operating models
- agentic-AI-embedded workflows and domain rewiring
- enterprise analytics strategy
- global tech talent and efficiency
- core technology architectures, from cloud to platform hosting
of insured US lives represented across organizations we’ve served in the past three years
experienced healthcare consultants
CAPABILITIES
Nebula Platform
Our cloud-based, HITRUST-certified data analytics platform helps healthcare payers connect data, uncover insights, and improve performance:
- Comprehensive datasets: closed claims data covering ~220 million lives
- Core reference sources: clinical risk segmentation models; national provider affiliation data; county-level enrollment; service-line growth forecasts; and demographic projections
- Applications: modules for value analytics, population health stratification, competitive intelligence, and growth analytics to enable faster, data-driven decision-making
Databases and benchmarking tools
Our proprietary databases and benchmarking tools help payers measure performance, identify improvement opportunities, and benchmark success against peers:
- Medical policy database and clinical rules engine: automated, structured database with policies built from comprehensive medical and clinical guidelines
- Site-of-care optimization tools: rapidly identify opportunities to shift care to more cost-efficient settings across infusions, minor surgical procedures, imaging, lab, and more
- Medical spend benchmarking: taxonomy-driven benchmarks to evaluate medical cost performance relative to peers
Technology enablement tools
Our tools help healthcare payers translate technology into sustained business impact:
- Technology evaluation framework: rapid assessments of existing platforms with clear improvement roadmaps
- AI for Data Quality (AI4DQ): interoperable AI and machine learning modules to enhance data quality pipelines and workflows
- Agents@Scale: vendor-agnostic platform for defining, orchestrating, and deploying AI agents via low- or no-code approaches
- GAIL: interoperable modules for common gen AI application patterns, deployed through containerized microservices
EXAMPLES OF OUR WORK
$1 billion in organization-wide process improvements
Helped a leading US national payer identify over $1 billion in administrative and medical cost savings by improving its automation programs, demand management, and geographic footprint across business lines.
Seamless cloud migration for 14 million members
Helped a multistate health insurer migrate its core claims-processing platform serving 14 million members—its largest cloud migration to date—with no unplanned outages and no disruptions to critical business processes.
$300 million to $500 million in savings through value-based care
Assisted a large, regional Medicare payer increase the share of members in full-risk value-based care from 5 percent to more than 30 percent—potentially saving $300 million to $500 million over three years.
Healthcare insights that power innovation at scale
Our latest thinking on how healthcare leaders can translate strategy into measurable impact: advancing clinical excellence, elevating patient and member experience, unlocking AI-enabled value, and strengthening performance across the full ecosystem.