Markets
Built for health plans first.
Medicare Advantage, Medicaid, commercial, and employer-sponsored are four distinct markets, different regulators, buyers, quality frameworks, and economics. We treat them that way.
Medicare Advantage lives, half-Star swings move tens of millions in bonus payments
Medicaid & CHIP members (CMS, March 2026), state quality frameworks and redetermination churn
ACA marketplace enrollees for plan year 2025 (CMS), all rated under the QHP Quality Rating System
Employer-sponsored covered lives, a distinct buyer from individual commercial
Sources: CMS Medicaid & CHIP Enrollment Highlights (March 2026), CMS 2025 Marketplace Open Enrollment Report, KFF Employer Health Benefits Survey (2025).
Medicare Advantage
Close gaps in care, lift Stars, and move CAHPS across the population that drives bonus payments and rebates.
- HEDIS-aligned engagement (KED, EED, CBP, ADD-E, and more)
- Stars and gap-in-care programs tied to measure-level ROI
- CAHPS-focused member experience touchpoints
- D-SNP and dual-eligible engagement workflows
Medicaid
A distinct book with its own quality framework, rate cells, and churn dynamics, not a variant of commercial. Built for state-specific measure sets and the redetermination cycle.
- Redetermination and retention outreach through eligibility churn
- State-specific HEDIS and quality withhold measures
- Maternal health, well-child, and behavioral health engagement
- Health equity data capture (REL, SOGI, SDOH screening)
Commercial & individual (ACA marketplace)
Fully-insured commercial and individual/exchange lines, a separate market from employer-sponsored group business. Differentiate the benefit, retain members, and steer them toward higher-value care.
- Preventive care, screenings, and healthy-behavior rewards
- QHP quality rating and marketplace member experience lift
- Steerage to lower-cost, higher-quality sites of care
- Journey orchestration across care management partners
Employer-sponsored (plan-distributed)
A separate segment served through the health plan relationship, deployed when a carrier or ASO sponsors wellness under a group or self-funded book. Not the same buyer or benefit design as commercial individual coverage.
- HRAs, biometrics, tobacco-free attestations, and vaccinations
- Benefit navigation and point-solution activation
- Rewards tied to premium reductions and CDH deposits
- ASO / self-funded group compatibility
Not sure where you fit?
We've stood programs up across every line of business. Tell us the population and the measure you're chasing, and we'll sketch the shortest path there.
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