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Surescripts
In a fragmented healthcare system, it can be hard to exchange information efficiently
As a health plan, you’ve built up tremendous expertise in healthcare management. Your data gives you a unique opportunity to improve members’ health. But when providers and care managers don’t have up-to-date patient insights, expenses balloon—and the member experience suffers.
Communication gaps hinder care management.
It can be hard to connect with providers promptly and securely with medication updates or member care concerns. And the data your own care management teams need is often delayed.
Only 17% of physicians can easily find medication adherence data electronically.1
62% of patients say privacy protections are more important than easier access to their health data.2
Clinicians prescribe without seeing the full picture.
When your members’ prescription benefit plan details aren’t easy to find, prescribers make medication decisions without a clear view of patient costs and coverage.
Cost has deterred 53% of patients from taking a medication.3
Moving to electronic prior authorization could save health plans $99 million a year in labor costs.4
Solutions
Enable fully informed, cost-effective care decisions
Intelligent Prescribing
Lay the groundwork for safe prescriptions that align with your members’ benefit plans by sharing coverage information with clinicians.
Interoperability
Inform treatment and transitions of care by giving clinicians and your own care managers more patient insights and better communication channels.
Intelligent Prior Authorization
Reach clinically appropriate prior authorization decisions as quickly as possible, so patients can start treatment sooner.
Benefit & Price Intelligence
Share prescription benefit intelligence when and where it’s needed, making it easy to choose the best medication.
Care Team Evolution
As care delivery evolves, help your members receive exceptional care wherever they seek it with more clinical and cost information in practitioner workflows.
Value-Based Care
Help pinpoint opportunities to improve adherence, avoid unnecessary costs and close gaps in care with a sharper view of your members’ medication history, and benefits.
Real-world results
Tap into a single, powerful QHIN™ connection
A new era of clinical information exchange is here. As a designated QHIN, Surescripts Health Information Network is ready to help you take full advantage with InterconnectTM.
One powerful connection to the point of care
A trusted network with nationwide reach
Surescripts processes 27.2 billion health data transactions per year.5
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One channel to reach nearly every prescriber
Surescripts connects 2.29 million healthcare professionals and organizations.6
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Collaborating to drive change through healthcare
Surescripts works closely with organizations such as AHIP and NCPDP to advance innovation.
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Find out more about Health plans
How does Surescripts help health plans reduce prescription abandonment?
By enabling real-time benefit information and more efficient prior authorization workflows, Surescripts solutions help prevent cost surprises and long delays, which can lead to prescription abandonment. Health plans can also receive prescription notifications for potential issues such as running out of refills or an abandoned prescription, enabling timely interventions.
What interoperability capabilities are available for health plans?
Surescripts connects 2.32 million healthcare professionals and provider organizations, bringing a comprehensive and connected view of care when and where it’s needed most. Health plans can use Surescripts solutions to give clinicians and their own care managers more patient insights and better communication channels.
How does Surescripts support value-based care initiatives for health plans?
Surescripts helps health plans advance value-based care by improving visibility into medications, coverage and care activity. Products such as Clinical Direct Messaging, Medication History for Populations and Real-Time Prescription Benefit help deliver timely insights that support adherence, reduce avoidable costs and close gaps in care across provider networks.
How does Surescripts approach security and compliance for health plans?
The Surescripts network adheres to standards set by leading privacy and security organizations, including the gold standard of cybersecurity: the NIST Cybersecurity Framework. We hold a HITRUST r2 Certification as well as certifications from the Electronic Healthcare Network Accreditation Commission (EHNAC) and DirectTrust.
Keep pace with healthcare innovation
- Surescripts, “Data Brief: Physician Perspectives on Access to Patient Data,” April 2018, p. 1.
- Morning Consult and America’s Health Insurance Plans, “Price Transparency Polling Presentation,” January 2020, p. 3.
- Surescripts, “Prescription Price Transparency and the Patient Experience,” February 2020, p. 2.
- CAQH, “2019 CAQH INDEX: Conducting Electronic Business Transactions: Why Greater Harmonization Across the Industry Is Needed,” 2020, p. 17.
- Surescripts, “2024 Annual Impact Report,” March 2025, p.5.
- Surescripts, “2024 Annual Impact Report,” p.5.