MARKETPLACE SOLUTIONS

Network Solutions

The MacroHealth Marketplace Platform helps Payers design strategic and cost-effective solutions for out-of-area and
out-of-network care, supporting smarter architecture and
better member access.

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Cost Control That Travels
with Your Members

Out-of-area strategies help provide coverage for quality, low-cost care to members that travel to or live outside the primary
area the plan covers, while out-of-network solutions help manage claim costs that are outside of in-network contracts.

This ensures that your members receive better coverage, lower costs, and less balance billing –
contributing to an overall improved member experience.

One Comprehensive Platform for Network Strategy

With MacroHealth, gain access to market data, coupled with industry-standard interoperability that equips Payers with the means to curtail claims and administration costs, ultimately elevating the quality of care delivered.

Explore the MacroHealth Marketplace Platform
Identify Best-Fit Health Market Partners

The MacroHealth Marketplace Platform analyzes Payer’s claims and identifies Health Market Partners that could increase coverage for members and reduce overall claims costs.

Strengthen Data Connections

MacroHealth connects Payers and Health Market Partner that best fits their needs, through a single, reusable data connection.

Build a Toolkit of Solutions

Use a variety of tools for out-of-network costs, including payment integrity solutions, NSA solutions, and payment negotiation.

Network Solution Capabilities

Build Smarter Networks

  • Layer multiple network partners to expand access and maintain competitiveness.
  • Identify optimal partner configurations with network optimization analysis tools.

Drive Greater Savings

  • Identify areas of claims for optimization to drive overall plan savings.
  • Understand the holistic and transparent view of your claims pricing.

Improve Member Experience

  • Optimization analysis identifies optimal networks and configurations that benefit your member population.
  • Ensure reimbursement and help reduce claim costs to prevent balance billing.
  • Understand the holistic and transparent view of your claims pricing.

Resources

Case Study: UHA Health Insurance  

Case Study

Case Study: UHA Health Insurance  

UHA Health Insurance, based in Honolulu, Hawaii, sought guidance in their search for a more comprehensive mainland network solution. 

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MacroHealth Overview Brochure

Brochure

MacroHealth Overview Brochure

Together with our Payers and Health Market Partners, MacroHealth has built a multi-sided platform to modernize the healthcare marketplace b…

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Navigating Out-of-Network Healthcare Costs: Unpacking Factors that Impact Pricing

Blog

Navigating Out-of-Network Healthcare Costs: Unpacking Factors that Impact Pricing

In the ever-evolving landscape of healthcare pricing, a pressing question emerges: How will out-of-network (OON) healthcare costs be impact…

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Testimonials

“We approached MacroHealth for a simple solution to optimize our net profits and are pleased with the favorable results we have received for both gross and net savings. Also, their team is professional, responsive, and easy to work with. If you are looking to optimize your offerings, ask for MacroHealth, they deliver!”

Valérie LocteauDirectrice Principale Assistance Médicale Voyage
Senior Director Travel Medical Assistance

“MacroHealth has helped UHA to offer a robust, high-quality network of physicians and hospitals for our members while they are away from Hawaii. We are pleased to work together with MacroHealth in this effort to offer a simpler and easier experience to our members.”

Contracting Services ManagerUHA Health Insurance

“MacroHealth’s actionable and real-time data gives Providence Health Plan a competitive edge with prospective member groups. Through our collaboration with MacroHealth, we’ve seen significant reductions to the level of effort needed to operationalize and connect to network and pricing solutions.”

Chief Growth OfficerProvidence Health Plan

“MacroHealth is an easy company to work with. They have great people who understand our business and work collaboratively to help us achieve our goals. I highly recommend using MacroHealth for your savings needs in the US.”

Taka KatsubeCost Management and Medical Assistance Director

“When we selected our new national network, Aetna Signature Administrators, it was critical that we find a partner like MacroHealth who could help us navigate the implementation process and necessary data exchanges. Throughout the implementation process, MacroHealth quickly surfaced, analyzed, and organized a complex and encompassing set of needed requirements. Their expertise helped us keep momentum and led to a smooth rollout. We’re pleased to welcome them as a long-term partner.”

Tony Kopki Vice President of Commercial Programs

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