New advanced analytics platform delivers actionable insights into market rates, powers competitive, cost-effective, and compliant networks for healthcare consumers.
Zelis, a healthcare technology company modernizing the healthcare financial experience, today announced the launch of Healthcare Insights 360. This new healthcare intelligence solution pairs data from Zelis’ robust network analytics solutions with intelligent technology that collects, normalizes, and translates the billions of cost data elements that have recently become available through the federal Transparency in Coverage Rule.
The rule requires companies offering health insurance coverage to disclose in-network provider-negotiated rates via machine-readable files (MRFs). As-is, these payer MRFs are difficult, if not impossible, to read and use:
- The data sets are extremely large. To find a single rate for a physician at a facility requires querying billions of lines of data in real-time.
- The data are too limited to have value alone without appending additional information and adding context, including provider demographics.
- The data are noisy. Every contracted rate for a provider is required to be included regardless of whether or not they offer that service. For example, Zelis found chiropractors with cesarean delivery rates and an allergist with rates for knee joint replacement.
Zelis’ Healthcare Insights 360 addresses these challenges by making the data digestible down to the specific CPT codes, facility, and provider, empowering both collective containment on rising costs as well as enhancing individual payers’ market position.
Indeed, this capability has never been more critical, as healthcare costs have risen to $4.3B and benefit costs alone are expected to rise by 5.4% in 2023.
Zelis’ Healthcare Insights 360 empowers payers to:
- Understand how an organization’s cost position compares to the national, regional, and local market to hone financial planning and expansion opportunities.
- Make strategic decisions for geographic-based plan growth, like entering or exiting markets, based on cost and provider performance.
- Identify opportunities and risks related to how an organization’s contracted rates compare to competitors.
- Leverage pricing data to showcase plan value to prospective employer clients by quantifying value.
“Healthcare Insights 360 provides payers with a one-stop shop to analyze MRF files and improve their network position,” says Pam Klein, General Manager of Healthcare Intelligence. “We’re excited to leverage Zelis’ deep understanding of rate data and the analytics infrastructure needed to deliver meaningful insights for our clients to help them achieve their business goals while also controlling costs for the industry at large.”
Healthcare Insights 360 is built on Zelis’ proven technology, vast data sets, and expertise creating, ingesting, and analyzing MRF files. This new solution was built with a flexible in-house infrastructure that allows data storage and processing to evolve quickly as MRF formats evolve. Especially of interest are the clear visualizations that simplify complex data into easily digestible insights.
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