TodayManage the claim after care
Cost is reviewed only once care has already happened, and the claim has already been created.
Care
ClaimCost Management
ClaimCost Management
Control how specialty care enters your health plan — before claims are created.
.svg)
.png)
The ShiftHealCo governs how specialty care enters the plan—before the claim is created.
TodayCost is reviewed only once care has already happened, and the claim has already been created.
ClaimCost Management
With HealCoGovernance is applied at the entry point — before a pathway is chosen, and before a claim exists.
GovernanceRoutingCareClaim
Make the governing decision before specialty care becomes a claim.
Define how care enters and moves through your plan.
.svg)
Establish clinical criteria and pathway steps.
.svg)
Set provider supply, approved options, and capacity.
.svg)
Apply rules, benefits, and incentives that guide decisions.
.svg)
Publish the governed pathway with confidence.
.svg)
Maestro applies the pathway at the point of entry.
cc.png)
Maestro turns plan governance into action — routing members, enforcing pathways, and recording each decision back to Decision Desk.
.png)
Governed Routing: Executes pathways configured through Decision Desk.
Pathway Enforcement: Applies employer-defined rules, clinical criteria and approved care options at entry.
PPO Fallback: Preserves the existing network when a governed pathway doesn’t apply.
Decision Logging: Records routing actions back to the governance record.
See the decisions, actions, and evidence behind governed care.
.png)
Real-world evidence from HealCo's operating experience—built through years of care delivery, network collaboration, and governance in action.
Can't find the answer to your question? Send us an email and we'll get back to you as soon as possible!
Contact UsHealCoHP is not a network-first product. Traditional PPOs rely on broad networks and post-claim cost control. HealCoHP is built around direct care, bundled pricing, and intelligent navigation that guides members to the right care before claims occur. PPO access may exist as a fallback, but it’s not the primary decision engine.
No. HealCoHP is not an insurance carrier. It is a care and navigation layer that works alongside an employer’s underlying plan structure (self-funded, level-funded, or association-sponsored). HealCoHP focuses on how care is accessed, priced, and routed — not on underwriting risk.
HealCo’s AI navigation guides members at key decision points — symptoms, referrals, procedures, and follow-up care — using plan context, pricing logic, and provider availability. The goal is to steer members toward high-quality, cost-effective care paths before unnecessary utilization or surprise costs occur. Human support remains available where appropriate.
Yes. HealCoHP is designed to support small and mid-sized employers, including those that traditionally lack leverage in healthcare purchasing. Depending on structure, small employers may participate through association-sponsored plans, pooled models, or level-funded arrangements, while still accessing the same navigation and care infrastructure.
The COHP model shifts healthcare from a carrier-owned system to a community-aligned care model. Instead of value being captured primarily by intermediaries, care decisions, pricing, and incentives are aligned around employers, providers, and members. HealCoHP operationalizes this by combining direct care, bundled services, and transparent navigation into a cohesive system.
Can't find the answer to your question? Send us an email and we'll get back to you as soon as possible!
Contact UsView all briefs
.png)
Start with a focused deployment or request a brief to explore the fit.
(1).jpeg)
.avif)
.png)
.png){kind=icon}
.png)
.png)
.png)