Carelon Insights

Carelon offers a platform designed to enhance healthcare sustainability by optimizing care and cost efficiencies across the healthcare system. Central to its offering are three key components: Medical Benefits Management, Payment Integrity, and Advocacy. The platform focuses on optimizing specialty and post-acute care, guiding care to the most appropriate settings, including in-home care. It also incorporates specialty care tools and post-acute care tools, aiming to connect providers with the expertise and technology necessary for better clinical decisions, which, in turn, significantly impacts health plans. 

The Advocacy component of Carelon Insights' platform stands out by offering a personalized concierge service, especially for members with complex healthcare needs. It is purpose-built to manage large, progressive employer groups and uses automated insights, program innovation, and verified insights to deliver a comprehensive, scalable solution.

In April 2024, CarelonRx released a new service named SpecialtyRx Savings Navigator, which aided companies in managing special medication expenses and providing assistance to employees who need these medications. The key features of SpecialtyRx Savings Navigator included advanced analytics to identify high-risk members, a comprehensive review of the member's health status and care options, and pharmacist-led interactions to remove care barriers. It also offered employers disease-specific projections for future medication expenses, optimized health plan design recommendations, and custom member support to reduce costs.

Key customers and partnerships

As of February 2024, Carelon Insights serves over 68 million members across all 50 states in the US. 

In 2017, Carelon Insights partnered with Interim HealthCare. The partnership focused on transforming post-acute care in the home and combines Carelon Insights’ approach with Interim HealthCare's extensive network of professionals across states. Together, they work to optimize the quality and affordability of post-acute home care.