vendor

COPE Health Solutions is a national technology-enabled services and platform company serving health plans and risk-bearing provider organizations. The company provides third-party administration, business process as a service, and core health plan administration under a single accountable partnership model. Health plans can delegate one function or an entire operating model — product, network, sales, enrollment, claims, contact center, medical management, care management, finance, and compliance — through one contract, one platform, and one team accountable for outcomes. The model is designed to replace the fragmentation that results from managing separate vendors for utilization management, quality, risk adjustment, and core administration.

Capabilities span nine operational domains: medical management, including medical policy administration and full-service utilization management; quality, covering Star Ratings, HEDIS, and state regulatory program management; financial management, including capitation, shared risk, risk adjustment, actuarial services, and MMR processing; data, reporting, and compliance, with FHIR-enabled interoperability and enterprise data warehousing; enrollment and billing; claims processing from intake through payment, including COB, subrogation, and encounters; contact center operations with AI-enabled digital agents and IVR; product development, pricing, and filing; and network management, credentialing, and provider directory administration. Functions are delivered directly or orchestrated through a managed network of technology and operations partners, with COPE Health Solutions retaining single-point accountability.

All capabilities operate on ARC, the company’s population health and operations platform, which serves as the unified data, workflow, and oversight layer across delegated functions. ARCi, an agentic AI layer, automates routine administrative and clinical work and surfaces exceptions requiring attention. The organization holds NCQA Certified Data Partner status for Data Aggregator Validation, NCQA Prevalidation for Population Health Management, NCQA accreditation for care management, and a HITRUST r2 assessment, and is included in KLAS Research coverage.

Engagements typically begin at one of three entry points: accelerated HEDIS and Star gap closure; margin improvement targeting utilization, risk adjustment, and cost drivers affecting medical loss ratio, with shared downside risk available where appropriate; or full health plan operating model delegation. Because each runs on the same platform, scope can expand without changing partners.

Learn More | Schedule a Demo | Follow on LinkedIn

Contact:
Kathryn Honeycutt
Vice President
336.391.4545
khoneycutt@copehealthsolutions.com

1150 S Olive Street, Suite 1200
Los Angeles, CA 90015
copehealthsolutions.com