These networks impact the pricing, administration, and quality of health insurance programs. They determine the basic competitiveness of healthcare markets, and their owners have become the de facto gatekeepers of innovation, flexibility and collaboration. Information is opaque, especially regarding the cost of service, and there are limited opportunities for users to make healthcare decisions based on cost. Compounding the problem: hundreds of isolated unique networks, maybe large for a market but lacking scale to the nation, all operating in their own silos, all with their own approach and protocols.
Currently, health insurance networks are the foundational building block of most health care spending in the United States. These networks impact the pricing, administration, and quality of health insurance programs. They determine the basic competitiveness of healthcare markets, and their owners have become the defacto gatekeepers of innovation, flexibility and collaboration. Information is opaque, especially regarding the cost of service, and there are limited opportunities for users to make health care decisions based on cost. Compounding the problem: hundreds of isolated unique networks, maybe large for a market but lacking scale to the nation, all operating in their own silos, all with their own approach and protocols.
Our goal in creating OpenNetworks is to remove barriers to collaboration and innovation in how healthcare is financed and paid for. We believe removing those barriers will also drive innovations in how care is organized and delivered.
The power of an open network of healthcare providers offering competitive payment arrangements cannot be overstated. Almost every attempt at innovation in the healthcare industry runs into dominant, centralized organizations who ultimately govern who wins and who loses.
OpenNetworks seeks to simplify and improve the relationship between payers and healthcare providers. We also want to promote healthcare organizations of all kinds to explore the ‘art of the possible’. For this reason, our software is being architected to enable a multitude of organizations to offer their services through our platform. Whether those are services being offered to employers, to healthcare providers or to any other user of the platform.
Our goal is to build a library of APIs that enable innovation in every dimension of our work together. We believe disease management companies, value-based payment programs, revenue cycle management companies, identity verification companies, remote monitoring technologies and data analytics approaches, to name just a few, can find expression on our platform.
For health systems, physicians and other medical providers, OpenNetworks enablesvariable pricing aligned with their respective business rules and capabilities. It’s nolonger just about price, or one price fits all. Nor should it be.
For all participants, OpenNetworks makes every transaction more consistent, simpler toadminister, and more accurate. Gone are the days of error caused through legacysystems implementing varying claim edits and medical management protocols. Byleveraging the powers of web 3.0, different systems and organizations can interactseamlessly, reducing friction in data exchange and process integration. Unifiedprotocols will provide a standardized framework for recording transactions acrossdifferent participants. And smart contracts, with terms written directly into code, willensure standard execution and reduce potential errors.
OpenNetworks also opens new markets and new revenue streams for providers. Byenabling direct contracting with simplified online tools and marrying together thesurround sound of supporting capabilities which are “bolted on” to the platform, local,smaller employers are now able to participate in direct relationships with providerswithout the burden of massive staffing to approach and contract. And Providers canbuild a network within the network to curate and build a market/regional/nationalnetwork of like-minded providers on price, attribute and location, and approachbusinesses with unique solutions to address the varying needs of their employees,regardless of location.
Payers of all types will have access to the platform, with the opportunity to use thenetwork to best meet their needs. Full replacement of networks, carve-outs/carve-ins,supplemental market support networks, addressing white space concerns, or building adirectly contracted network for various conditions. And given that the network enablescuration by attribute, price, capability and business rule, providers open their doorseasily to new business while payors are able to deploy value based strategies,population health, bundles and other approaches to enhancing quality and loweringcost.
OpenNetworks enables variable pricing aligned with a providers respective businessrules and capabilities. For payers, a mirror view is enabled via our proprietary Latch™ technology enabling the defining of a network contemplating matching business rules,capabilities, and value. Transparency and AI tools will support decision-making for bothpayers and providers. Support partner tools enable assessments for meeting fiduciary responsibility and network access standards.
Differentiation, market positioning and value are featured, with an ability for all to modeltheir results based on prices set within the market. Analytic tools support the ability toproject revenue streams and profitability, and support business decisions.And all use the network as they desire. Full replacement, wrap, carve-outs/carve-ins,supplemental networks, addressing white space concerns, or building a directlycontracted network for various conditions.
OpenNetworks enables variable pricing aligned with a providers respective business rules and capabilities. For payers, a mirror view is enabled via our proprietary Latch™ technology enabling the defining of a network contemplating matching business rules, capabilities, and value. Transparency and AI tools will support decision-making for both payers and providers. Support partner tools enable assessments for meeting fiduciary responsibility and network access standards.
Differentiation, market positioning and value are featured, with an ability for all to model their results based on prices set within the market. Analytic tools support the ability to project revenue streams and profitability, and support business decisions. And all use the network as they desire. Full replacement, wrap, carve-outs/carve-ins, supplemental networks, addressing white space concerns, or building a directly contracted network for various conditions.
