HEALTHESYSTEMS

Specialty pharmacy benefits management and ancillary services for workers' compensation payers

Specialty Solutions Established Bootstrapped

Overview

Healthesystems (also operating as Healthe) is a specialty pharmacy benefits manager (PBM) and ancillary benefits management (ABM) services provider focused exclusively on workers' compensation. Founded in 2002 and headquartered in Tampa, Florida, the company brings over 23 years of experience helping payers, carriers, and employers manage pharmacy program utilization and costs for injured workers.

The company combines clinical expertise with proprietary technology to connect stakeholders, drive better clinical decisions, streamline processes, and improve outcomes for injured workers. Healthesystems serves workers' compensation payers across the United States, with additional offices in Tempe, Arizona.

As a privately held, bootstrapped company, Healthesystems operates as an independent specialist in the workers' compensation benefits management space, offering pharmacy benefits management alongside ancillary services such as diagnostics, home health, durable medical equipment (DME), and physical therapy coordination.

Products & Services

Pharmacy Benefits Management (PBM)

Specialized PBM services built specifically for workers' compensation claims. The platform manages medication utilization, drug utilization review, and claims technology processing, integrating clinical pharmacist expertise with proprietary technology.

Key Features

Drug utilization review and clinical oversight
Workers' compensation-specific formulary management
Claims technology and processing integration
URAC-accredited PBM platform (accreditation through January 2028)

Target Users: Workers' compensation carriers, TPAs, self-insured employers

Ancillary Benefits Management (ABM)

Management and adjudication of ancillary medical services for injured workers, coordinating a network of vendors and service providers for non-pharmacy medical needs.

Key Features

Vendor coordination and network management
Diagnostics, home health, DME coordination
Physical therapy and rehabilitation services management
Claims adjudication for ancillary services

Target Users: Workers' compensation payers, managed care organizations

Clinical Services

Proprietary clinical review services combining technology with clinical pharmacist expertise for managing complex medical cases in workers' compensation claims.

Key Features

Clinical pharmacist oversight and consultation
Complex case management support
Drug interaction and contraindication review
Evidence-based clinical decision support

Target Users: Carriers, TPAs, and employers with complex injured worker cases

Data Analytics and Reporting

Industry insights, data analysis tools, and performance reporting to help clients understand program trends and outcomes.

Key Features

Program performance dashboards
Industry benchmark data
Annual Workers' Comp Industry Insights Survey (8th edition published 2026)
RxInformer journal (twice-annual clinical education publication)

Target Users: Workers' compensation payers seeking program intelligence

Patient Resources

Tools and resources for injured workers navigating pharmacy and medical benefits.

Key Features

Pharmacy search tools
Ask-a-pharmacist functionality
Patient resource portal

Target Users: Injured workers, claims adjusters

At a Glance

Founded: 2002
Headquarters: Tampa, Florida, USA
Employees: 201-500
Funding: Bootstrapped

Category & Focus

Category: Specialty Solutions
Subcategories: Workers' Compensation PBM Ancillary Benefits Management Clinical Services
Insurance Verticals: Workers Compensation
Target Customers: Carriers, TPAs, Employers