Health plans need deep expertise in high-volume conditions every day. Complex therapies are different. A plan may see only a handful of transplant or cell or gene therapy cases in a year—yet each one requires specialized policies, provider criteria, clinical review, patient support, and contracting and financial strategy.
Emerging Therapy Solutions gives health plans an immediately available toolkit so internal teams can stay focused where their volume—and their members—need them most.
The flexibility of the solution is important. A health plan may want a complete end-to-end program or it may only need certain components.
For example, a plan might need:
ETS360 allows health plans to keep the infrastructure and capabilities it already does well, add specialized resources where maintaining them internally doesn’t make sense, better understand what is coming within its population, manage the underlying cost of complex therapies, protect broader provider relationships, and create a differentiated offering for employer clients.
WHAT ETS360 MANAGES
HOW ETS360 WORKS FOR HEALTH PLANS
Predict™Use monthly surveillance, forecasting and Proactive Patient Identification to plan staffing, clinical resources, budgeting and reinsurance needs—while ongoing pipeline intelligence keeps your teams current as the market evolves.
Navigate™Access therapy-specific Centers of Excellence and site-of-care expertise while keeping your core provider relationships intact.
Care™Use ETS medical policy, rapid prior authorization / utilization management, physician review, appeals and patient support as much—or as little—as your internal model requires.
Protect™Use transparent episode-of-care contracts, cost and claim management, outcomes protection, and stop-loss or reinsurance solutions to manage the remaining exposure.
Health plans can use ETS360 in the way that best fits their existing infrastructure, strategy and internal resources.
For Finance
Know expected exposure. Improve budgeting and reinsurance strategy.
For Clinical & Pharmacy
Access current policy, clinical criteria, pipeline intelligence and expert review.
For Network
Avoid reopening broad provider contracts for rare, highly specialized episodes.
For Operations
Staff to expected volume rather than building and maintaining excess specialized capacity.
For National Accounts
Differentiate the plan with embedded complex-therapy capabilities and population-specific insights that help employer clients understand and prepare for their own exposure.
For Education & Leadership
Keep teams current through ETS University, continuing education credits (CEUs) and ongoing market intelligence.
ETS360 gives health plans immediate access to the specialized intelligence, clinical expertise, network infrastructure and financial tools required for complex therapies—without requiring internal teams to build and maintain capabilities they may use only a few times a year.
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