THE PRIZM PLATFORM
Explore the full spectrum of data-driven insights
NETWORKS
Custom Network Comparisons
Identify the most cost-effective network for your population* and support fiduciary compliance by importing a census file to run group-specific network comparisons.
*Input weights for specific geographic areas and claims types to get results that accurately reflect a group's distribution and utilization.
INPUTS
OUTPUTS
NETWORKS
Network Comparisons by Procedure
Ensure fiduciary alignment by evaluating how your existing health plan network compares to alternative networks for specific high-cost procedures and services, with the option to view rates as a % of Medicare or % discount from billed charges.
NETWORKS
Network Comparisons by Code
Assess whether proposed direct contract rates for a Center of Excellence are competitive with rates offered through a commercial insurer's network, with the ability to drill down by code for the most frequently billed procedures.
RATES
Market Benchmarking
Secure more competitive contracts and ensure fair reimbursement rates with up-to-date information.
RATES
Peer Comparisons
See how much insurance carriers are paying you relative to your provider peers.
RATES
Uncover Revenue Opportunities
Calculate revenue opportunity based on adjusting your rates for existing service offerings.
RATES
Spot Rate Variability
If you spot high variability in a health plan, dive deeper to see if there's a specific hospital driving the variability.
SHOPPING
Meet Healthcare Transparency Requirements with Confidence
Comply with Transparency in Coverage requirements by providing a shopping tool that allows members to estimate cost-sharing for covered healthcare services and procedures.
Features
Transparency in Coverage
Personalized Cost Estimates
Offer plan-based cost & provider data.
Service & Procedure Lookup
Quickly find relevant healthcare services.
Plan Comparisons
Compare different healthcare plans.
DATA
Healthcare Price Transparency Data, Wherever It's Needed
Empower your customers and teams by enhancing existing systems and workflows with insights generated from enriched hospital price transparency data and health plan price transparency data. Integrating healthcare price transparency data into your system enables:
- Benchmarking of negotiated rates across payers
- Procedure-level cost comparisons
- Provider-level cost comparisons
Quick & Easy Access
PRIZM Data can be seamlessly integrated into analytics platforms, internal dashboards, or other workflows via API or delivered as custom data extracts that contain only the data fields you require.
Full Spectrum Insights
Insights are generated from enriched data from multiple sources, including payer and hospital MRFs, geographic metadata, provider demographic and billing information, and several public CMS datasets, including local Medicare reimbursement rates.
Up-to-Date, Maintenance Free
PRIZM Data is ready-to-use, helping ensure access to the latest insights while saving your organization time and money on data acquisition, data maintenance and data cleanup.
IMPACT
Enhance Network Analysis
Determine the appropriate provider network discount assumptions when pricing aggregate and specific stop-loss insurance coverage for self-funded employer groups.
Make comparisons across carrier networks and regions, modeling the impact on discounts across varying claim sizes and mix of services.
View up-to-date discount factors for all regional and national health insurance carriers.
View discounts presented from first dollar and above and below a comprehensive set of specific deductibles.
