Lower Claims Costs. Happier Members.
Too many members go to the ER when they don't need to — and avoid it when they should. Connect PearMDx to your member app and give your members 24/7 symptom guidance that steers them to the right level of care. Every clinical standard is set and maintained by our medical review team and validated against published guidelines.
The Reality for Health Plans
Why HMOs Need Smarter Symptom Guidance
These are the challenges HMO product leaders face every day — and what happens when you connect PearMDx.
ER Visits That Didn't Need to Happen
Members rush to the ER for non-emergency conditions — driving up claims costs significantly. Many could have been safely managed with routine care or a pharmacy visit.
Members Don't Know Where to Go
Members can't tell when symptoms warrant a hospital visit vs. a pharmacy trip vs. self-care. This leads to both over-utilisation of expensive facilities and dangerous under-utilisation.
No Visibility Into Member Health
Health plans lack real-time data on member symptom patterns, making it impossible to proactively identify at-risk populations or design preventive care programs.
What Happens When You Connect PearMDx
Your Members Get Answers. Your Claims Costs Drop.
Connect PearMDx to your member app and watch utilisation, satisfaction, and costs improve together.
Members Get Instant Guidance — Day or Night
Connect PearMDx to your member app and your members can check symptoms at 2am on a Sunday — getting clear, evidence-based guidance on whether they need the ER, a clinic visit, or safe self-care at home. No nurse hotline wait times. No guessing. Just a clear answer in under 5 minutes.
- Available 24/7 — nights, weekends, and public holidays
- Works inside your existing member app or patient portal
- Clear, member-friendly language — no medical jargon
- Under 5 minutes from first symptom to a clear recommendation
Every Member Routed to the Right Level of Care
Instead of guessing, your members get routed to exactly the right level of care. When you connect PearMDx, members receive four-level triage guidance: emergency room for true emergencies, clinic for urgent issues, routine in-person consultation for follow-ups, and self-care when it's safe.
- Four care levels matched precisely to member needs
- Non-urgent members redirected away from expensive ER visits
- Members routed to in-network providers first
- Nearest facility recommendations so members know exactly where to go
Fewer ER Claims. Lower Per-Member Costs.
Every unnecessary ER visit that PearMDx prevents saves your health plan money. When you connect PearMDx to your member channels, non-emergency cases are guided to appropriate, lower-cost care settings — reducing per-member claims costs while actually improving health outcomes.
- Fewer non-urgent ER claims per member per year
- Members guided to cost-effective care settings automatically
- Better health outcomes through earlier, appropriate care
- Measurable ROI from the first month of deployment
See What's Happening Across Your Membership
Every assessment PearMDx runs generates structured health data. You can now see symptom trends across your entire member population, identify at-risk groups before they file claims, and design preventive programs based on real data — not guesswork.
- Assessment analytics and usage dashboards per facility
- Regional disease prevalence data informing every assessment
- Data to design targeted preventive care programs
- Member engagement and usage analytics
PearCare — Standardised Triage Across Your Clinic Network
Roll out PearCare across your clinic network — a unified, branded triage interface that ensures every partner clinic delivers the same clinical standard, with centralised analytics and governance. Each facility gets its own branded instance, managed from your central dashboard.
- Unified clinical standard across all partner clinics and facilities
- White-label branded interface — your HMO identity, your clinical governance
- Centralised analytics dashboard across all deployment locations
- PIN-based staff authentication with facility-level role management
- Available as a per-facility add-on to Professional and Enterprise plans
The Member Journey
From First Symptom to the Right Care
Here's what your members experience after you connect PearMDx to your app.
- 1
Member Opens Your App
A health plan member wakes up with symptoms at 2am, or notices something worrying during the day. Instead of rushing to the ER or ignoring it, they open your member app and tap "Check My Symptoms."
1Member Opens Your App
A health plan member wakes up with symptoms at 2am, or notices something worrying during the day. Instead of rushing to the ER or ignoring it, they open your member app and tap "Check My Symptoms."
- 2
Quick Symptom Check — Under 5 Minutes
The member answers a guided set of questions about their symptoms — what they're feeling, how long it's been happening, and their medical history. Simple language, no medical jargon.
2Quick Symptom Check — Under 5 Minutes
The member answers a guided set of questions about their symptoms — what they're feeling, how long it's been happening, and their medical history. Simple language, no medical jargon.
- 3
PearMDx Assesses Urgency
PearMDx analyses the symptoms against a curated African knowledge base — 30 conditions fully modelled for the MVP and expanding — applies African disease intelligence, and runs six independent clinical checks to determine the right urgency level.
3PearMDx Assesses Urgency
PearMDx analyses the symptoms against a curated African knowledge base — 30 conditions fully modelled for the MVP and expanding — applies African disease intelligence, and runs six independent clinical checks to determine the right urgency level.
- 4
Member Gets a Clear Next Step
The member sees a clear recommendation: "Go to the ER now," "Book a clinic visit this week," "Visit your pharmacy," or "Safe to manage at home." No ambiguity. No jargon.
4Member Gets a Clear Next Step
The member sees a clear recommendation: "Go to the ER now," "Book a clinic visit this week," "Visit your pharmacy," or "Safe to manage at home." No ambiguity. No jargon.
- 5
Your Team Gets Structured Data
Every assessment generates structured data for your health plan — symptom patterns, utilisation trends, and population health insights you can use for preventive care programs.
5Your Team Gets Structured Data
Every assessment generates structured data for your health plan — symptom patterns, utilisation trends, and population health insights you can use for preventive care programs.
By the Numbers
Member Experience You Can Measure
Always Available
Members get guidance any time — nights, weekends, and public holidays.
Care Levels
From emergency to self-care — every member is routed to the right place.
Medical Oversight
Every clinical standard is reviewed by our medical review team and validated against published guidelines.
Conditions Modelled
Fully modelled for the MVP — including endemic African diseases that global-only platforms miss entirely — with the knowledge base expanding.
Where You Connect PearMDx
Meet Members Where They Already Are
Connect PearMDx to any digital channel your members already use — no new apps to download.
Member Mobile App
Connect PearMDx to your health plan's mobile app. Members get instant guidance without leaving the app they already trust.
Nurse Hotline Support
Connect PearMDx to your nurse hotline. Nurses see structured assessments alongside the caller, speeding up triage decisions and improving consistency.
Member Portal
Connect PearMDx to your web-based member portal. Members can assess symptoms from any browser, anytime, anywhere.
Trust & Transparency
Clinical Governance You Can Count On
PearMDx isn't unsupervised AI. Every clinical standard is set, maintained, and reviewed by real medical professionals.
Medical Review Team Oversight
Our medical review team and clinical professionals set every clinical standard PearMDx follows. Low-confidence results are flagged for clinical review to ensure assessment quality.
Source Citations in Every Assessment
Every recommendation includes references to the medical literature that informed it. Your clinical team can verify the reasoning independently — no black boxes.
Knowledge Base Updated Continuously
The medical knowledge base is constantly refreshed with the latest evidence, reviewed and approved by clinical professionals. Outdated sources are flagged and replaced.
Clinically Validated. Built for Africa. Ready to Deploy.
Start your free pilot with 200 assessments — no credit card required. See how AI symptom guidance changes member outcomes and claims costs.