The cost and quality of providers vary widely, even within a single specialty in a single market. Where patients get their medical care directly impacts the cost of care and clinical outcomes.

Physicians are often in the driver’s seat when it comes to site of service decisions—they’re making referrals for patients who need to see a specialist or go to a facility. However, most physicians we work with still say they don’t know enough about the cost and quality of providers in their market. They use the same specialists or facilities over and over because of an existing relationship—it’s ‘the devil you know.’

Today, physicians are inundated with programs attempting to influence referral patterns, such as utilization management (which can feel like penalties) or value-based care arrangements, like accountable care organizations (ACOs), that attempt to limit referral pathways to a closed network.

What if we could provide physicians with the right data and the right incentives to help them break habits?Clarify Advance harnesses proven behavioral economics principles to provide physicians with personalized referral recommendations and incentives for sending patients to the most cost-effective network option. It is a 100% benefit-based program without penalties, designed to make it easy for physicians to save patients – and payers – money.

“This program is such a better, forward-thinking approach to engaging and working with physicians—rewarding us instead of constantly penalizing us.”


Advance Program, Dallas

Best of all, this type of program can be deployed quickly and can sit on top of either a fee-for-service or value-based contract arrangement. This is good news for health plans that want to add more value to their physician relationships. No re-contracting is required, which drives voluntary physician enrollment. Physicians love that the financial rewards go directly to them or their staff and that the program is centered on helping their patients.

“When we have the opportunity to partner with our payers to save patients money, it’s a win-win on both sides.”

VP of Payor Relations

Urology Clinics

For a program like this to work it must be easy for providers. This can be an uphill battle in today’s cumbersome healthcare technology ecosystem. For example, if you are an orthopedic surgeon, you likely have separate portals, with separate logins, to access images from radiologist clinics or bloodwork results from the lab. And then you have your own electronic medical record system with its own login and password. None of these systems speak to each other, which frustrates physicians.

Clarify Advance is not a portal.

“I’m just glad it’s not another damn portal.”


Advance Program

Clarify Advance is a lightweight experience for physicians and their staff. Program participants receive monthly and quarterly progress reports via email with timely and actionable data and recommendations. No logins. No overly tooled platforms. Just insights in their inbox and a supportive, hands-on coach that help them decrease the cost of healthcare for their patients.

What’s the secret sauce to making Clarify Advance so motivating?

  1. Personalization: Personalized lists of preferred specialists and facilities are generated for each physician. These recommendations are specifically designed to be achievable, offering each physician an attainable way to improve without fully disrupting their practice patterns. Along the way, Clarify Advance tailors messaging and motivators based on a physician’s performance to goal. That’s as personalized as it gets.
  2. Frequent rewards: Healthcare providers instantly see the incentives they can earn. The payouts are made regularly so that the reward is directly tied to the cost-saving decisions that were made and it’s routed directly to the decision-maker versus hitting the practice’s bottom line.
  3. Hands-on support: If you ask any physician, ‘When you try to reach out to a payer, what has been your experience, and exactly how long do you spend on the phone before you reach a real person?’ the answer isn’t pretty. The Clarify support team is always available to talk with providers directly. We will sit with the office scheduler to review the facility list. We can help automate the facility list within the EMR system. We want physicians and patients to see real cost savings. Our goal is to help them succeed.

In a recent survey of 82 physicians participating in the Clarify Advance program launched at a national health plan, 74% said saving their patients money was their main motivation for using Clarify Advance. It’s as simple as that.

Here’s how physicians ranked their reasons for staying in the Advance program

Interestingly, when we look at motivators by participant role, PCPs are less passionate about saving their patients money than leadership, staff, and specialists. Practice staff place the highest value on earning incentives compared to leadership, PCPs, and specialists. Having no risk associated with participation is most important to the practice leadership. Specialists in general are more interested in participating in new quality programs than other roles.

Here’s what motivates Advance Program participants in different roles to change behavior patterns

What do we really mean by actionable insights? 

“This is exactly what I would want to happen to me if I was in my physician’s office. I would want someone to tell me what was my most affordable imaging option.”

Radiology Manager

Advance Program

Offering physicians preferred options that they are willing and able to use is vital to achieving high voluntary physician engagement and behavior change. This is why curating specific options for every physician is so important.  For example, an orthopedic surgeon’s list would be created based on:

  1. Which facilities they have used before, which helps establish where physicians are credentialed and have block time.
  2. Which facilities are most affordable and clinically appropriate for the specific types of procedures the physician typically conducts (e.g., knees, hips).
  3. Which facilities are within a specific distance of their office and their patient panel.

Giving provider’s transparency into how they’re performing in a way that is personalized and timely drives behavior change. Imagine an orthopedic specialist learning from just one email that: 1) compared to last year, they are using the most affordable facility 20% less often than last year 2) they could be saving patients $12,700 and earning an additional $4,600 if they focused on this for upcoming procedures. Imagine knowing—very clearly knowing—when they leave money on the table and what they can do about it next time. And even better, know exactly how much their patients are saving. And all physicians have to do is check their email (see below). We don’t want complicated care. We want better care.