NexUS is a value-based healthcare product solution that improves patient outcomes at lower costs for everyone.

The NexUS model aligns provider and employer incentives and focuses on the cost drivers of health plans to reduce cost. Savings start with every member selecting a primary care provider (PCP).

Value-Based Incentive Payments

Through NexUS, participating health plans will also focus on physicians, paying for better outcomes and savings based on performance. Each participating PCP is measured in these areas: site of service, access, quality, referrals, and utilization.

Member Engagement

Patients with a consistent source of care from the same physician have greater satisfaction with their overall healthcare compared to others. Patients with a PCP also experience lower rates of emergency department use for non-urgent conditions. The NexUS model encourages members to select a primary care provider or one will be auto-selected for them. However, they will not need approval from their primary care provider to see a specialist.

The NexUS healthcare delivery model will also identify high-risk members based on claims and clinical data. Care Navigators will support primary care providers in managing, engaging high-risk members by coordinating care. This means patient needs and preferences are known and communicated at the right time to the right people, and that this information is used to guide the delivery of care.

Care Navigators

Care Navigators assist high-risk members by providing care management, coordination and education. In addition, the navigator will help physicians develop a care plan, provide, follow up on emergency room visits and hospital admissions as well as readmissions.

Extensive evidence also demonstrates a positive relationship between chronic care interventions – like NexUS Care Navigators – having a positive impact on both quality care and improving health outcomes for asthma, congestive heart failure, depression, and diabetes.