Harnessing AI to parse billions of data
points and deliver fast, accurate pricing
By Lori Widmer
For Handl Health, the challenge was too good to pass up. When two newer regulatory requirements were enacted that required hospitals and health plans to meet new pricing transparency requirements and publish their data in machine-readable files (MRF), CEO and co-founder Ahmed Marmoush and his team knew it was an opportunity to transform the experience for brokers and their employer clients.
Marmoush says that the legislation opened the industry up to new possibilities. “This legislation means that, for the first time in history, employers and advisors could access comprehensive pricing data across all networks and providers—but the raw files are massive, complex and difficult to use.”
It was also a great opportunity for Handl Health to transform that data into what Marmoush says will give brokers and their clients a way to translate mountains of pricing data into precise insights.
But how do you take an exceedingly complicated process of determining accurate pricing—sifting through slews of data points, manual updates, and relying on competing carrier information—and simplify it to speed the process and delivery regulatory compliance? It’s by introducing AI and human intelligence into the equation.
That’s where Handl Health’s Iris, an AI-driven network analytics solution, gives users something that didn’t exist before—the ability to access carrier negotiated rates without restrictions. Moreover, Iris allows users to evaluate networks and see the underlying factors that make up the pricing structure.
“Traditionally, brokers and employers had to rely on historical claims data and costly, time-consuming repricing exercises to evaluate networks,” says Marmoush. “Even then, the results were typically expressed only as a ‘discount,’ which is misleading because it doesn’t reveal the actual denominator, making it nearly impossible to compare networks in a meaningful way.”
Iris, Marmoush says, delivers clarity “by instantly repricing either a claims file upload or a simulated claims basket across networks using the federally mandated [machine readable files data. This approach reveals true, dollar-based costs—not vague discounts—and organizes results by clinical category for clarity.”
Also, brokers can benchmark across geographies and payers, he says. They are also able to create provider performance models tied to actual utilization. Other features include disruption and steerage analysis, direct-to-provider contracting insights, and health plan optimization strategies that are accurate and effective.
“Producers looking to expand their book of business
can use simulated claims to show prospects powerful,
data-driven insights with only minimal information.”
—Ahmed Marmoush
CEO and Co-founder
Handl Health
“We worked together to make sure that what they were seeing in their output was what we would expect, based on our knowledge and experience in the different marketplaces. That process took some time, but they were incredibly open.”
—Gary Alton
Senior Vice President, National Accounts
The Partners Group
All this accuracy delivers another benefit: the opportunity for business growth. Marmoush says that because producers are able to evaluate network options without needing a claims file, the tool delivers some serious growth potential. “Producers looking to expand their book of business can use simulated claims to show prospects powerful, data-driven insights with only minimal information,” he says. “This helps them stand out against competitors who still rely on vague discounts or claims-heavy processes.”
What users say
For The Partners Group, the responsiveness of the Iris product, and of the Handl Health team, has delivered exactly what they were looking for—to individually validate carriers and network discounts easily. “From a historical standpoint, we needed to get a claims file from the incumbent carrier, send it to another carrier via [non-disclosure agreement], then let them reprice those claims,” says Gary Alton, senior vice president of National Accounts for The Partners Group.
Carriers, he says, were typically returning with their network discounts and saying they were better. “The question was, ‘How do you independently validate that?’ We had to go through every reprice and look for outliers and spend a significant amount of time internally to verify the accuracy of the discounts. This was a very time-consuming process and now our internal validation time has been drastically reduced.”
For Emily Young, employee benefits consultant for The Partners Group, why this product was developed answers why it’s so effective. “The tool is going out and gathering publicly available data—billions of different data points that the carriers must make available now,” she explains.
“[I]mplementation was very easy. They trained a few of us and now we are working to train our
consulting team.”
—Emily Young
Employee Benefits Consultant
The Partners Group
Before Handl Health, she says, “there was nothing a normal person could do with these billion data points. This technology goes out, collects them all, and provides this easy-to-digest report.”
The selection process, says Young, was fairly easy for them. “We researched multiple companies who were building similar tools, and we thought Handl was the best option,” which she credits to Handl’s ability to develop a strong relationship “and willingness to update their tool based on feedback from our team.”
They’ve also been able to evolve along with Handl and the Iris system. “The selection process really evolved over time because their product was evolving as well,” says Alton. “The people at Handl are incredibly smart. They were also incredibly open to feedback because what we got out of the gate took some time to refine.
“We worked together to make sure that what they were seeing in their output was what we would expect, based on our knowledge and experience in the different marketplaces. That process took some time, but they were incredibly open.”
As for getting up and running on the Iris system, Young says, “Handl’s implementation was very easy. They trained a few of us and now we are working to train our consulting team. There’s still work to be done as far as training our consultants on our side, but everyone does have the ability to access the Iris reporting system, and it will be an important tool for our team to have to help support our clients and manage their healthcare spend in the future.”
The Partners Group, says Alton, continues to work with the Handl team, which is looking to add new levels to their Iris offering. Alton gives an example: “You got a great network or you’re saying this is the best network discount that we can get. Here’s your lowest cost. Then the next level up is to consider what is member disruption?
“It’s great if we can save 7%, but if half of our member population at Employer X is going to be disrupted and they’ll have to go to new providers or new facilities or hospitals, is that disruption worthwhile? That’s a conversation we need to have with our clients, and Handl gives us the capability to have those data points to have that conversation.”
It is an ongoing conversation that Handl is invested in, as well. “Healthcare spending is one of the largest and least transparent expenses for employers, yet traditional tools left them without a clear way to evaluate networks,” says Marmoush. The problem of relying on slow, costly repricing processes that didn’t deliver transparency did much to mask the true underlying cost, he says.
“Iris was built to solve that problem,” Marmoush adds. “By instantly repricing either actual or simulated claims across networks using the MRF data, Iris provides employers and advisors with a clear, dollar-for-dollar comparison of true costs. This enables smarter contracting and plan design decisions, but it also opens new doors for producers; even without access to claims, they can still show prospects how different networks perform and where savings exist.”
That, he says, will give producers the information they need to differentiate and compete while ensuring accuracy and regulatory compliance.
The author
Lori Widmer is a Philadelphia-based writer and editor who specializes in insurance and risk management. BrokerTech Spotlight offers a look at insurtech offerings from startups that have partnered with BrokerTech Ventures (BTV), a convening platform for brokers, carriers and wholesalers, and tech firms, and includes insight from other BTV member owners.
