PRODUCTS
RealSight
Reshape market dynamics | Build consumer-first strategy | Gain strategic advantage
What's in it for payers?
According to the CMS Transparency in Coverage Rule, from July 2022, Payers are required to publicly disclose negotiated rates of all services provided by their in-network providers and out of network allowed amounts in Machine-Readable Files (MRFs).
CitiusTech’s Price Transparency Solution - RealSight - ingests and curates publicly available Machine Readable Files (MRFs) to enable the following outcomes for Payers:
Reshape market dynamics by harnessing the true potential of
price transparency
Build consumer-first strategy
with redesigned & customized
product lines
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Gain strategic advantage with competitive pricing reducing
overall cost of care
Reshape market dynamics by harnessing the true potential of
price transparency
Build consumer-first strategy
with redesigned & customized
product lines
Gain strategic advantage with competitive pricing reducing
overall cost of care
Starting with MRF data, health plans and health systems stand at a junction to innovate and monetize using the power of healthcare datasets for multiple operations
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Price Transparency & its Challenges
Most Payers intend to capitalize on publicly exposed information to get a competitive edge in the market but, here are several concerns to be aware of
Enormous volume of data is now available in the market, but is not easily interpretable or consumer-friendly on its own without a super-computer
Data accessibility is a challenge because payers have followed different approaches to publish their machine-readable files
Data inconsistencies from CMS mandated formats, mismatches and outdated numbers are at large making it difficult to analyze and extract a larger picture
MRF data in silo is insufficient unless combined with provider demographics, taxonomy related information to derive meaningful insights
Enormous volume of data is now available in the market, but is not easily interpretable or consumer-friendly on its own without a super-computer
Data accessibility is a challenge because payers have followed different approaches to publish their machine-readable files
Data inconsistencies from CMS mandated formats, mismatches and outdated numbers are at large making it difficult to analyze and extract a larger picture
MRF data in silo is insufficient unless combined with provider demographics, taxonomy related information to derive meaningful insights
Why RealSight?
Accelerate compliance and strategic organizational objectives
Regulatory Compliance
MRF Engine to generate MRFs of In-network negotiated rates as per CMS rule
Curated Data as a Service
Scalable Data Platform to ingest & store publicly exposed healthcare data & share prepared data for analytics
Insights for Payer Operations
Analytics apps for payer use cases e.g., network operations, VBC strategy, claim pricing, actuarial
Enabled Smart Network Navigation
Direct to consumer delivery of price transparency-based analytics via digital front door
Regulatory Compliance
MRF Engine to generate MRFs of In-network negotiated rates as per CMS rule
Curated Data as a Service
Scalable Data Platform to ingest & store publicly exposed healthcare data & share prepared data for analytics
Insights for Payer Operations
Analytics apps for payer use cases e.g., network operations, VBC strategy, claim pricing, actuarial
Enabled Smart Network Navigation
Direct to consumer delivery of price transparency-based analytics via digital front door
Advantages of RealSight
One-stop answer to all price transparency related questions!
Scalable data platform to ingest & store large volume of pricing information from National, Blues and other payers
Monthly curated data from multiple payers in readily consumable format for analytics use cases across payer value chain
Comprehensive data quality checks
and standardization to address data
inconsistencies, along with clinical
equivalence to analyze & extract a
larger picture
Flexible architecture to include additional payer domain datasets (claims, quality, membership etc.) for future use cases beyond MRF
Pre-built dashboards for specific payer workflows (network management) that can be further customized per client requirements
Reduced operational cost for payers to host and manage humungous datasets
Scalable data platform to ingest & store large volume of pricing information from National, Blues and other payers
Monthly curated data from multiple payers in readily consumable format for analytics use cases across payer value chain
Comprehensive data quality checks
and standardization to address data
inconsistencies, along with clinical
equivalence to analyze & extract a
larger picture
Flexible architecture to include additional payer domain datasets (claims, quality, membership etc.) for future use cases beyond MRF
Pre-built dashboards for specific payer workflows (network management) that can be further customized per client requirements
Reduced operational cost for payers to host and manage humungous datasets
Price transparency in Coverage provides enormous data publicly in the form of machine readable files and it takes a lot to activate this data and derive actionable insights. Find out how CitiusTech's Price Transparency Offerings can empower health plans with a strategic advantage through transformative analytics and actionable insights.
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