If you don't manage population health, the ER will
Clinical outreach covering 250K+ members on HRA programs, with outcomes tied to the Star measures your plan is defending.
12 of Top 15
US health plans
3 of Top 5
Blue (BCBS) plans
100M
lives touched across the value chain
Avasant RadarView™
Leader in Healthcare Payer Business Process Transformation
Everest Group PEAK Matrix®
Leader in Healthcare Payer Intelligent Operations
NelsonHall NEAT
Leader in Healthcare Payer Agility & Innovation
Everest Group
Front-runner in the Generative AI Healthcare Payer Market
NelsonHall
Leader in Healthcare Payer Operational Transformation
ISG Provider Lens™
Leader in Payer Transformation on Healthcare Digital Services
Everest Group PEAK Matrix®
Leader in Healthcare Payer Business Process as a Service Solutions (BPaaS)
WHY THIS MATTERS
The clinical cost is compounding
Every health plan medical director is facing the same three pressures at the same time.
STARS QUALITY BONUS
$12.7B
Medicare Advantage quality bonus payments totaled at least $12.7B in 2025. Plans that slip below 4 Stars watch that revenue move to competitors, and Stars are won in member health, not paperwork.
KFF, Medicare Advantage Quality Bonus Payments, 2025
MLR squeeze
91%
Average Medicaid managed care medical loss ratio hit 91% in 2024, the highest in a decade. Avoidable utilization is the difference between a managed cost and a margin event.
KFF, Health Insurer Financial Performance in 2024, 2025
Prior auth
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72 hours
As of January 2026, CMS requires prior authorization decisions within 72 hours for urgent requests. Slow clinical turnaround now carries both a member-experience and a compliance cost.
CMS, Interoperability and Prior Authorization Final Rule (CMS-0057-F), 2026
PROVEN OUTCOMES
What a licensed clinical operation actually moves
Live clinical outcomes programs across US health plans. These programs are operated by TeleMedik, a Firstsource company.
15% to 20%
fewer readmissions
Disease management programs cut readmissions by 15% to 20%, keeping chronic-condition members stable between visits.
~50%
ER intent redirected
A nurse advice line redirected ER-intent member calls in half, steering them to self-care or a physician visit.
79%
consults resolved to self-care
Across the physician telemedicine service, 79% of completed consults resolved to self-care, with no prescription, lab, or in-person visit.
60%
reached a 5% weight reduction
In a pilot wellness program, 60% of 378 participants reached a 5%-plus weight reduction through coaching and nutrition.
population health solutions
Where clinical work runs, end to end
From nurse advice through prior auth, one licensed operating model built to move Stars and reduce avoidable utilization.
Clinical outreach that avoids the ER
TeleMedik, a Firstsource company, runs nurse advice and physician telehealth that redirect ER-intent members to the right setting, with 79% of completed consults resolving to self-care.
- 24/7 clinical access
- Multilingual support
Chronic care won between appointments
Disease management keeps more than 13,500 members engaged across diabetes, COPD, CHF, and cardiac conditions, cutting readmissions 15% to 20%.
- Remote monitoring
- Care coaching
- Risk stratification
HRAs completed, not chased
Digital HRA outreach across multiple languages keeps more than 250,000 members on assessment programs and lifted HRA closure rate by 12%.
- Multilingual digital HRA
- Feeds risk and care gaps
- Stars-aligned
Gaps closed at member level, by AI
AI agents for care gap closure identify unscreened members and trigger telehealth consults in real time, closing HEDIS gaps between annual visits.
- Member-level identification
- Real-time telehealth trigger
- Between-visit engagement
Prior auth in minutes, not days
AI agents and copilots for prior authorization cut turnaround from days to minutes for Medicare Advantage plans and reduce pended claims by up to 50%, with clinical accuracy maintained throughout.
- Clinical accuracy held
- MA and government lines
- CMS-0057-F aligned
Lifestyle change that reverses risk
Wellness programs such as En Cuerpo Sano drive measurable risk reduction; across 378 participants, 60% reached a 5%-plus weight reduction through coaching and nutrition.
- Prediabetes reversal cases
- Behavioral health
- SDOH-aware
CLIENT SPOTLIGHT
When the call dropped, the nurse's call back saved a life
A nurse on TeleMedik's Nurse Advice Line reconnected after a man in his fifties collapsed mid-call from a sudden cardiac event. She reached his wife, guided her through CPR adapted for his tracheostomy, and counted compressions until EMS arrived 8 minutes later. He was defibrillated on scene with pulse restored before hospital transfer.
"When he collapsed, his wife froze. The nurse didn't. She stayed on the line, guiding every compression until paramedics arrived and brought him back."
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500,000+
members covered
WHO WE SERVE
Your line of business determines where Stars are won
Stars gaps look different in Medicare Advantage than in Medicaid. We build for both.
National plans
Stars exposure across every measure, every line
Multi-line national plans carry HEDIS, CAHPS, and Part D Stars exposure simultaneously. Firstsource manages chronic condition programs for 13,500-plus members with readmissions down 15% to 20%.
Blues plans
Local populations need localized outreach
Blues plans serve defined regional populations with specific chronic condition and SDOH profiles. Multilingual HRA outreach and community health workers close gaps that digital-only campaigns miss.
Self-funded
Chronic condition costs land on the employer
Self-funded employers bear the direct cost of unmanaged chronic conditions. Disease management programs reduce readmissions and ER utilization, with outcomes underwritten in the commercial model.
PROOF OF DELIVERY
Live clinical programs, each proving a different result
Disease management, assessments, and prior auth, each from a live clinical operation.
13,500+
members in disease management
More than 13,500 members are actively managed across chronic-condition programs, with readmissions down 15% to 20%.
250K+
members on HRA programs
Digital HRA outreach across multiple languages keeps more than 250,000 members on assessment programs and drives Stars-aligned care gap identification.
50%
fewer pended claims
A Medicare Advantage plan deployed an AI agent for prior auth and cut pended claims by up to 50%, with turnaround from days to minutes.
INSIGHTS
Latest from the Firstsource team
Insights from the field, real operations, real outcomes, and perspectives from the people making it work in live operations.
Case Study
Building a strong foundation for growth: how a leading dental plan transformed operations with strategic partnership
Discover how a leading dental plan partnered with Firstsource to transform operations, reduce costs, improve CSAT, and enable scalable growth through AI and a hybrid delivery model.
Contact Us
Stars are won between visits, not at them
That is where the work starts.
- Clinical operations with TeleMedik, a Firstsource company.
- Priced on readmissions reduced, gaps closed, and Stars measures moved.
- 13,500+ members managed and 250,000+ on HRA programs today.