Competitive Pricing

Competitive Pricing

Competitive Pricing

Competitive Pricing

OVERVIEW

OVERVIEW

OVERVIEW

OVERVIEW

With developing legislation ruling that healthcare providers and insurers need to publish negotiated rates, we identified an opportunity to drive market competition by exposing market rates.

With developing legislation ruling that healthcare providers and insurers need to publish negotiated rates, we identified an opportunity to drive market competition by exposing market rates.

With developing legislation ruling that healthcare providers and insurers need to publish negotiated rates, we identified an opportunity to drive market competition by exposing market rates.

With developing legislation ruling that healthcare providers and insurers need to publish negotiated rates, we identified an opportunity to drive market competition by exposing market rates.

Zelis Healthcare

Zelis Healthcare

Zelis Healthcare

Zelis Healthcare

2023-2024

2023-2024

2023-2024

2023-2024

TEAM

TEAM

TEAM

TEAM

Product Design Manager (my role)

Product Design Manager (my role)

Product Design Manager (my role)

Product Design Manager (my role)

Product Managers

Product Managers

Product Managers

Product Managers

Data Engineers

Data Engineers

Data Engineers

Data Engineers

Account Management

Account Management

Account Management

Account Management

Sales

Sales

Sales

Sales

(001)

Leading to inflated patient costs, the lack of competitive pricing in US healthcare can be attributed to:

Leading to inflated patient costs, the lack of competitive pricing in US healthcare can be attributed to:

Leading to inflated patient costs, the lack of competitive pricing in US healthcare can be attributed to:

01

Opaque pricing structures

Opaque pricing structures

02

Complex billing processes

Complex billing processes

03

Market consolidation

Market consolidation

04

Negotiation power imbalances

Negotiation power imbalances

05

Limited price transparency

Limited price transparency

(002)

Insurance plan administrators were already engaging with our Network360 dashboard tool, which made it the perfect candidate to host a new competitive rate analytics module.

Insurance plan administrators were already engaging with our Network360 dashboard tool, which made it the perfect candidate to host a new competitive rate analytics module.

Insurance plan administrators were already engaging with our Network360 dashboard tool, which made it the perfect candidate to host a new competitive rate analytics module.

(003)

The value of this tool lies in our ability to augment unstandardized client-supplied data and display rate insights in meaningful ways, including:

The value of this tool lies in our ability to augment unstandardized client-supplied data and display rate insights in meaningful ways, including:

The value of this tool lies in our ability to augment unstandardized client-supplied data and display rate insights in meaningful ways, including:

01

Network segmentation

Network segmentation

02

Provider types

Provider types

03

Contracted services

Contracted services

04

Price distribution and deviation

Price distribution and deviation

05

Geographic network strength

Geographic network strength

(004)

When looking for rate information, an administrator may be looking for patterns or details. Our users helped us identify top-down and bottom-up methods of finding rate information.

When looking for rate information, an administrator may be looking for patterns or details. Our users helped us identify top-down and bottom-up methods of finding rate information.

When looking for rate information, an administrator may be looking for patterns or details. Our users helped us identify top-down and bottom-up methods of finding rate information.

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(005)

Medical rate data is unstandardized, infrequently updated, and often inaccurate, which deteriorates the effectiveness of this tool. Until the Transparency in Coverage law is enforced, insurers will continue to delay providing good data.

We're actively exploring ways to grade the data quality in an attempt to encourage better data hygiene.

Medical rate data is unstandardized, infrequently updated, and often inaccurate, which deteriorates the effectiveness of this tool. Until the Transparency in Coverage law is enforced, insurers will continue to delay providing good data.

We're actively exploring ways to grade the data quality in an attempt to encourage better data hygiene.

Medical rate data is unstandardized, infrequently updated, and often inaccurate, which deteriorates the effectiveness of this tool. Until the Transparency in Coverage law is enforced, insurers will continue to delay providing good data.

We're actively exploring ways to grade the data quality in an attempt to encourage better data hygiene.