Health plans

Impact care decisions with actionable intelligence

Learn how Surescripts can help you control costs, improve member satisfaction and spend fewer resources on administrative work and retrospective compliance initiatives.

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.

When you have a medication update or concern about a member’s care, it can be hard to connect with providers promptly and securely. 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

Help care managers and providers make fully informed, cost-effective care decisions.

I need to...

Reduce costs and improve formulary compliance.
Automate and streamline prior authorizations.
Improve care management and network optimization.
Keep care managers informed of important care events.
Close gaps in care and coordinate value-based care activity.

Eligibility & Formulary

Give prescribers and pharmacists insight into the most preferred and cost-effective medication options at the group/plan level from the start.

Real-Time Prescription Benefit

Give clinicians accurate, member-specific information on costs, coverage and alternatives that are less costly or avoid prior authorization.

Electronic Prior Authorization

Automatically send questions directly to prescriber workflows, receive answers and attachments, send responses and initiate renewals. 

Record Locator & Exchange

Give your care managers timely insight into where members have received care and access to clinical documentation.

Care Event Notifications

Alert your care managers to key events for patients in their programs, such as a doctor visit, admission, discharge or receiving medication.

Clinical Direct Messaging

Securely communicate with providers and deliver important updates about formulary changes, drug safety notices and gaps in care.

One powerful connection to the point of care

A trusted network with nationwide reach

Surescripts processes 21.7 billion health data transactions per year.5

One channel to reach nearly every prescriber

Surescripts connects 2.03 million healthcare professionals and organizations.6

Collaborating to drive change throughout healthcare

Surescripts works closely with organizations such as AHIP and NCPDP to advance innovation.

Contact us for more information

  1. Surescripts, “Data Brief: Physician Perspectives on Access to Patient Data,” April 2018, p. 1.
  2. Morning Consult and America’s Health Insurance Plans, “Price Transparency Polling Presentation,” January 2020, p. 3.
  3. Surescripts, “Prescription Price Transparency and the Patient Experience,” February 2020, p. 2.
  4. CAQH, “2019 CAQH INDEX: Conducting Electronic Business Transactions: Why Greater Harmonization Across the Industry Is Needed,” 2020, p. 17.
  5. Surescripts, “2022 National Progress Report,” March 2023, p.2.
  6. Surescripts, “2022 National Progress Report,” p.2.