Care Solutions Help Prevent High-Cost Claims From Escalating

Care Solutions reduce costs by guiding members through complex care needs, tightening utilization decisions, and preventing high-cost claims from escalating. Fragmented care can trigger avoidable costs and poor outcomes when members face delays, unnecessary ER visits, or gaps in transitions. OneVeracity’s Care Solutions provide support that keeps care moving, reduces avoidable ER utilization, and connects members to cost-effective, high-performing providers when it matters most. Services include pre-certifications, nurse-led care management, and guided care pathways with proactive outreach. The impact is measured through utilization and cost outcomes, including fewer avoidable ER visits and admissions, better care transitions, and reduced readmissions. One national client reported 456% ROI after adopting OneVeracity’s Care Solutions and other integrated programs.

Care Solutions delivers three core services that reduce delays, minimize waste, and improve outcomes across complex care. First, Pre-certifications provide fast, member-friendly approvals, typically 2-3 days versus a 10-day industry average. Second, nurse-led Care Management provides consistent guidance through serious illness or injury, helping members navigate treatment decisions and coordination. Third, Guided Care Pathways provide proactive, data-driven coaching, access to virtual specialty care, early intervention, and nationwide access to top-performing, cost-effective providers. Together, these services reduce avoidable utilization and help prevent escalation in high-cost claims. The approach is designed to work with existing plan arrangements while also providing account management, member support, and reporting that improve outcomes and cost control.

Care Solutions are designed to reduce avoidable delays that often drive cost and member frustration in complex care. A key service is pre-certifications with faster, member-friendly approvals, typically 2-3 days compared to a 10-day industry average. That speed matters because delays can lead to missed care windows, avoidable ER use, and cost escalation. Care Solutions also include nurse care managers who can engage members quickly, coordinate across providers, home health, caregivers, and community resources, and help keep care plans moving. The goal is timely decisions and coordinated support so members get to appropriate care sooner and clients see fewer gaps, fewer avoidable utilization events, and cleaner continuity of care.

Traditional case management can be reactive, engaging after costs have already escalated or after members have struggled through delays and fragmented handoffs. Care Solutions are designed to intervene earlier, keep care moving, and guide members through decisions that drive both outcomes and cost. The service mix combines faster pre-certifications, nurse-led guidance through serious illness or injury, and proactive guided pathways that connect members to cost-effective, high-performing providers. The result is fewer delays, fewer avoidable utilization events, and better care transitions. Services can be delivered standalone or bundled based on need, with a focus on clear support and measurable impact rather than broad promises.

Care Solutions are designed to work alongside existing carriers, vendors, and clinical resources by adding coordinated support where fragmentation typically creates cost and outcomes risk. The goal is not to replace what is already in place, but to reduce gaps in navigation, approvals, and complex-case coordination so members get timely guidance and care plans stay on track. Care Solutions support coordination across providers and care settings, including home health, caregivers, and community resources, which helps reduce delays and improve continuity. This approach lets clients strengthen utilization control and member experience without forcing a rip-and-replace change, while keeping results measurable.

Care Solutions measure impact using clear utilization and outcome metrics tied to avoidable cost drivers. Examples include reductions in avoidable ER visits and admissions, more efficient care transitions that reduce gaps and delays, decreased readmissions, improved chronic condition control, and reductions in inpatient days, admits, and PMPM total medical spend. These measures connect care coordination to both member experience and total plan cost. Clients also get reporting with actionable insights so they can see what is happening, understand why it matters, and adjust priorities over time. One national client reported 456% ROI after adopting OneVeracity’s Care Solutions and other integrated programs. Other clients have also seen a 22% reduction in inpatient days, a 14% reduction in admits, and a 32% reduction in PMPM total medical spend.