In the US, health spending grew 9.7% to $4.1 trillion in 2020[1]. This is the latest data point in a long-term trend expected to continue over the remainder of the decade, with health spending likely outpacing economic growth by 2030. A major contributing factor to the escalating costs of healthcare is the significant variation in health care prices that exists within our market today. Two different dimensions contribute to this variation:

  • On a claim-by-claim basis, two different Payers could pay prices that are up to a 1000% different from each other for the same procedure and diagnosis at a given Provider.
  • A similar dynamic exists at scale, at the Provider Network level. A given patient population can have great variation in the aggregate cost of claims based on the provider networks that they are utilizing. One network solution might increase or decrease the total cost of claims versus another by 10% or more.

Health care Payers, Employers and other Purchasers of health care services must make sure that they are navigating healthcare prices, contracts and provider networks to ensure they are paying the most efficient prices for health care services that drive the best outcomes for the health care consumers they serve.

A practical barrier to a more efficient healthcare market is that the job of Health Payers selecting and connecting to Provider Network partners is complex and time consuming. Attempting to blend their own regional captive or self-managed provider network, with other regional, national, and out-of-network vendors to create a complete network solution is difficult due to lack of transparency and integration complexity. Having a partner that helps enable Payers design and seamlessly connect to Provider Networks that are unique to their population based on their unique mix of geography, demographics, and coverage design enables greater access to cost efficient care.

MacroHealth creates a cloud-based healthcare ecosystem that focuses on helping health plan Payers optimize and connect to Provider Networks and cost management partners. We have created a first of its kind platform that leverages data science to create highly curated solutions for purchasers of healthcare services specific to each of their member populations. Using proprietary data ingestion processes, algorithms, and advanced analytics, our platform provides a Payer with unbiased market benchmarking to design Provider network solutions that are optimized for their populations. Additionally, leveraging Industry Standard Interoperability to connect healthcare partners ensures a seamless, real-time connection with healthcare provider networks and serves as a single connection point versus the myriad of point-to-point connections healthcare Payers have traditionally endured.

In this regard, we have created an efficient and Intelligent Health Marketplace that lowers healthcare and administrative costs. At MacroHealth, our mission is to make buying and selling healthcare services simple and powerful. If you are a Payer or Provider wondering how to reduce healthcare costs, get in touch with us today by filling out the online form on our contact page.

Like this article? Watch this space for new articles filled with actionable insight on healthcare industry trends and creating Intelligent Healthcare Markets to help you lower healthcare costs, achieve better margins and foster organizational growth.

[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet

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