Priced to the care, not the rebate
Program pricing is anchored to the care actually delivered and documented — not to a list price the plan never negotiated and a rebate it never fully sees. The plan can trace the dollar to the service.
One operating model
Three markets, one operational model.
The way a specialty program is funded changes who carries the risk — but it should not change how cleanly the program runs. Quantify Administrative Services administers the same disciplined model across all three markets: transparent pricing, clean-claim processing on a single Electronic Payer ID, and reporting tied to actual care delivery.
Self-funded
Employers and plan sponsors who pay claims directly want to see exactly what specialty dollars are buying. We administer programs with line-of-sight to actual care — not a bundled, rebate-obscured invoice — so the plan can manage the spend it actually owns.
Stop-loss
High-cost specialty claimants drive stop-loss exposure. Clean claims, complete clinical documentation, and continuous reporting give carriers and reinsurers the traceability they need — reducing surprises at reconciliation and supporting cleaner laser and renewal conversations.
Captive
Group and single-parent captives need predictable, well-documented specialty programs to protect the pool. Our administrative discipline and outcome reporting help captive members and managers underwrite specialty risk with data instead of guesswork.
Pricing
Transparent pricing tied to actual care delivery.
Traditional pharmacy-benefit economics are a black box. Spread pricing, rebate retention, and bundled administrative fees mean the plan rarely sees what a specialty therapy actually costs or what it is actually paying for. Quantify Administrative Services was built to invert that.
No black-box spread
We do not make our margin on the difference between what we pay and what we bill. Administrative economics are disclosed to the plan and its advisors — the opposite of the opaque PBM model.
Auditable, line by line
Every claim, every adjudication, and every remittance is traceable. Plans, brokers, and stop-loss partners can audit the program against the clinical record — in their format, on their cadence.
Data
Real-time clinical data drives benefit decisions.
Because Quantify Administrative Services was built alongside the clinical organizations it serves, benefit decisions are informed by the same data the care team sees — not a claims feed that lags reality by a quarter.
- Continuous physiologic data. Streaming vitals and device data from the clinical organizations inform whether a therapy is working — before the next authorization, not after the next invoice.
- Patient-reported outcomes (PROs). Structured outcome measures captured during care feed coverage and continuation decisions, so the benefit follows the clinical response.
- Continuous reporting. Adherence, persistence, time-on-therapy, and outcome trends are reported on an ongoing basis — not reconstructed at renewal from a stale claims extract.
- One connected record. The clinical data, the claim, and the remittance describe the same episode of care — giving plans and stop-loss partners a single, defensible source of truth.
Plan economics
Clinical outcomes that move plan economics.
Better-administered specialty care is not a cost center to be squeezed — it is a lever on total plan spend. When the clinical work is done well and documented cleanly, the economics follow.
Fewer avoidable ER visits
Continuous monitoring and clinician-led oversight catch problems before they become emergencies — reducing the avoidable acute events that drive the most volatile claims on a specialty population.
Higher therapy adherence
Adherence is tracked and supported by a named clinical team, not assumed from an autoship. Better persistence on the right therapy protects both the patient and the investment the plan has already made.
Better quality of life
Patient-reported outcomes and clinical measures improve when care is continuous and coordinated — and a healthier, more stable specialty population is a more predictable one to fund.
Talk to us
Let's look at your specialty spend.
Whether you sponsor a self-funded plan, place stop-loss, or manage a captive, we can walk through how a transparent, clinically-connected administrative model would run for your population.