Medical Price Transparency
Medical Price Transparency
Medical Price Transparency
Medical Price Transparency
OVERVIEW
OVERVIEW
OVERVIEW
OVERVIEW
In 2020, the U.S. Government passed the Transparency in Coverage law, requiring health plans to publish the cost of all covered medical services. As an existing white-labeled provider directory, the Zelis provider finder tool was naturally positioned to tackle a compliant solution for health plans.
In 2020, the U.S. Government passed the Transparency in Coverage law, requiring health plans to publish the cost of all covered medical services. As an existing white-labeled provider directory, the Zelis provider finder tool was naturally positioned to tackle a compliant solution for health plans.
In 2020, the U.S. Government passed the Transparency in Coverage law, requiring health plans to publish the cost of all covered medical services. As an existing white-labeled provider directory, the Zelis provider finder tool was naturally positioned to tackle a compliant solution for health plans.
In 2020, the U.S. Government passed the Transparency in Coverage law, requiring health plans to publish the cost of all covered medical services. As an existing white-labeled provider directory, the Zelis provider finder tool was naturally positioned to tackle a compliant solution for health plans.
Zelis Healthcare
Zelis Healthcare
Zelis Healthcare
Zelis Healthcare
2021-2024
2021-2024
2021-2024
2021-2024
TEAM
TEAM
TEAM
TEAM
Product Designer (my role)
Product Designer (my role)
Product Designer (my role)
Product Designer (my role)
Product Managers
Product Managers
Product Managers
Product Managers
Data Engineers
Data Engineers
Data Engineers
Data Engineers
Legal Counsel
Legal Counsel
Legal Counsel
Legal Counsel
(001)
Existing as a white-labeled provider directory, the Sapphire365 platform provides medical cost estimates using averaged patient claims for end-to-end procedures.
In contrast, procedure billing acts much like a dinner receipt, outlining the list of services rendered during a given procedure. These individual service rates are what the TinC mandate requires to be published and findable.
Existing as a white-labeled provider directory, the Sapphire365 platform provides medical cost estimates using averaged patient claims for end-to-end procedures.
In contrast, procedure billing acts much like a dinner receipt, outlining the list of services rendered during a given procedure. These individual service rates are what the TinC mandate requires to be published and findable.
Existing as a white-labeled provider directory, the Sapphire365 platform provides medical cost estimates using averaged patient claims for end-to-end procedures.
In contrast, procedure billing acts much like a dinner receipt, outlining the list of services rendered during a given procedure. These individual service rates are what the TinC mandate requires to be published and findable.
(002)
Collaborating with our health-plan partners, we formulated a two-year project outline encompassing approximately 30 UI requirements, along with a comprehensive data architecture and augmentation strategy.
Collaborating with our health-plan partners, we formulated a two-year project outline encompassing approximately 30 UI requirements, along with a comprehensive data architecture and augmentation strategy.
Collaborating with our health-plan partners, we formulated a two-year project outline encompassing approximately 30 UI requirements, along with a comprehensive data architecture and augmentation strategy.
(003)
All involved parties were part of a co-informing process as we navigated the new data intricacies afforded by the legislation.
All involved parties were part of a co-informing process as we navigated the new data intricacies afforded by the legislation.
All involved parties were part of a co-informing process as we navigated the new data intricacies afforded by the legislation.
Government Officials
Government Officials
Government Officials
Employing a grace period of non-enforcement while the industry produced the necessary solutions.
Employing a grace period of non-enforcement while the industry produced the necessary solutions.
Employing a grace period of non-enforcement while the industry produced the necessary solutions.
Health Plans
Health Plans
Health Plans
Working directly with healthcare providers to produce rates data.
Working directly with healthcare providers to produce rates data.
Working directly with healthcare providers to produce rates data.
Engineering Teams
Engineering Teams
Engineering Teams
Standardizing, consuming, and augmenting petabytes of new data.
Standardizing, consuming, and augmenting petabytes of new data.
Standardizing, consuming, and augmenting petabytes of new data.
Product/Design Teams
Product/Design Teams
Product/Design Teams
Creating compliant product solutions while informing data requirements.
Creating compliant product solutions while informing data requirements.
Creating compliant product solutions while informing data requirements.
Legal Teams
Legal Teams
Legal Teams
Interpreting the law and evaluating the compliance of proposed solutions.
Interpreting the law and evaluating the compliance of proposed solutions.
Interpreting the law and evaluating the compliance of proposed solutions.
(004)
(004)
TinC
TinC
Research and testing conclusively indicated there'd be a steep learning curve to the proposed solutions. This led us to fracture the TinC solutions into their own flow, leaving the existing experience unaffected.
Research and testing conclusively indicated there'd be a steep learning curve to the proposed solutions. This led us to fracture the TinC solutions into their own flow, leaving the existing experience unaffected.
Research and testing conclusively indicated there'd be a steep learning curve to the proposed solutions. This led us to fracture the TinC solutions into their own flow, leaving the existing experience unaffected.
(005)
Following the initial 30 UI requirements, all of the solutions were documented separately and signed off by the legal team of each of our health plan partners.
Following the initial 30 UI requirements, all of the solutions were documented separately and signed off by the legal team of each of our health plan partners.
Following the initial 30 UI requirements, all of the solutions were documented separately and signed off by the legal team of each of our health plan partners.
(006)
Leveraging continuous discovery practices, we've been able to leverage the new data infrastructure to improve the core product experiences and expand into rates analytical reporting.
Leveraging continuous discovery practices, we've been able to leverage the new data infrastructure to improve the core product experiences and expand into rates analytical reporting.
Leveraging continuous discovery practices, we've been able to leverage the new data infrastructure to improve the core product experiences and expand into rates analytical reporting.
Like what you see? let me know. Don't like what you see? let me know. Either way, lets chat.
Like what you see? let me know. Don't like what you see? let me know. Either way, lets chat.
Like what you see? let me know. Don't like what you see? let me know. Either way, lets chat.
Like what you see? let me know. Don't like what you see? let me know. Either way, lets chat.