PlanOptix: Providing Innovative Healthcare Price Transparency

History of Healthcare Price Transparency

The pursuit of healthcare price transparency has gained considerable momentum in recent years, notably the Transparency in Coverage Final Rule issued by the Centers for Medicare and Medicaid Services (CMS). This ruling mandates that every health plan in the country offering health insurance must disclose its pricing arrangements with providers as of July 1, 2022. Benefit Science Technologies (BST) and Claritev, which acquired BST in May 2023, recognized the importance of this ruling and its relevance to our mission of revolutionizing healthcare analytics through data-driven insights and tools.

Under the ruling, Machine-Readable Files (MRFs) must encompass in-network negotiated rates and historical rates for out-of-network services. Furthermore, these files must be available and updated monthly. We acknowledge the significance of this specific aspect of the ruling, aligning our efforts to empower stakeholders with the necessary information to navigate the complex pricing structures within healthcare.

An Industry Problem

The healthcare and healthcare insurance industry grapples with vast amounts of data flowing through their systems. However, a critical challenge lies in the shortage of experienced financial analysts or data analysts capable of effectively analyzing this wealth of information. As a result, the industry struggles to provide meaningful insights and harness the power of data to drive positive change.

“In the data science as a service space, healthcare professionals need easy-to-use, curated key information as they negotiate contracts.” – Neil Larson, Director of Data Services, BST.

The absence of skilled analysts hinders stakeholders from comprehending the intricacies of pricing structures, identifying cost-saving opportunities, and fostering collaboration among the various players in the healthcare ecosystem.

The lack of actionable insights derived from data analytics restricts the potential benefits of healthcare price transparency.

A Solution: PlanOptix™ by Claritev

Recognizing the pressing need for a comprehensive solution, BST partnered with Claritev to develop a groundbreaking platform — called PlanOptix™ by Claritev — to address these challenges in healthcare data analytics.

PlanOptix is an advanced analytics platform designed as a seamless and intuitive web application where users can not only find and extract the price transparency data they want, but more importantly can leverage sophisticated algorithms and machine learning to transform the raw data into actionable insights. PlanOptix enables users to prepare and execute strategic contract negotiations with providers, understand competitive positioning to drive sales and retention strategies; improve stop-loss premiums, optimize provider networks and more.

By providing a holistic view of pricing structures and utilization patterns, PlanOptix by Claritev equips brokers, consultants, medical carriers, and even providers with the means to make informed decisions in the context of healthcare price transparency. The tool empowers stakeholders to drive down costs, enhance the quality of care, and improve patient outcomes by leveraging the power of data-driven insights.

We recognize the paramount importance of healthcare price transparency in today’s landscape. Through our innovative PlanOptix platform, we offer a transformative solution to the challenges faced by the industry.

As stakeholders embrace these capabilities, the vision of a transparent and patient-centric healthcare ecosystem becomes tangible. You can now leverage usable data to improve contract negotiations, network strategy and care focus, and make informed decisions regarding the most efficient and effective care. Together, we can forge a future where informed decisions shape a healthcare landscape that benefits all. Contact us today to book a demo.