CARE COORDINATION connects all Care Solutions

NETWORK MANAGEMENT connects all Provider Solutions

A comprehensive approach at individual provider, full network, facility and provider practice levels.

Provider and facility scorecarding based on quality and cost measures—medical appropriateness, complications, repeat surgeries, opioid prescribing, and end-to-end surgical costs—enables us to easily identify outliers and top performers.

Performance improvement

is facilitated by sharing best practices from the highest quality providers with outlier providers to identify opportunities for change.

Network analytics and optimization,

using scorecard data, provide direction in developing high-performing networks and supporting value-based reimbursement programs.

Case rates, bundling

and post-surgical guarantees can reduce overall surgical costs and improve quality and expense predictability. Incentives can help drive member choice of top-performing providers.

Through data analysis, consultative partnerships

with providers, and creative financing approaches, Carenodes’s Provider Profiling Solution can help health plans improve provider relations and performance while delivering high-quality, cost-effective outcomes.


Musculoskeletal (MSK)

Manage escalating musculoskeletal (MSK) spend and utilization Carenodes Musculoskeletal Solutions provides a suite of capabilities to address MSK conditions and medical spend. Our member-focused, holistic approach includes early intervention to promote conservative care, outcomes and utilization monitoring to ensure appropriate treatments, and access to high-performing providers and Centers of Excellence (COEs).

  • Digital Tools. Remote access to care. Get access to virtual self management programs for best-in-class multimodal therapy consisting of physical exercises, relaxation exercises and education.

  • Care Management. Holistic and member-focused With advocacy at the core, members receive direct, digital or virtual access to specialized nurses and high performing providers throughout the continuum of care, from early pain onset through treatment and beyond.

  • Utilization Management Integrated programs Help reduce pre- and post medical expenses by addressing spinal disease, joint surgery and back pain care including surgery, pain procedures and outpatient therapies.

  • Nationwide Network Surgical. Carenodes collaborates with top facilities and physical health providers to help ensure quality care and convenient access at negotiated rates.