Use Case / Third-Party Administrators

Cost Containment Intelligence for Self-Funded Plans

Use hospital and provider benchmarks, imported quality context, and reusable analyst workflows to support steerage, employer reviews, and cost-containment strategy for self-funded plans.

The Challenge

Proving Value to Employer Clients

Repricing Accuracy

Discount-based repricing can hide inflated charge masters and weak market positions. Employer teams need defensible market evidence.

Reference-Based Pricing

RBP programs need local benchmark context to set and defend rates by service family and market.

Provider Steerage

Members may use high-cost facilities for routine procedures, but steerage requires cost, access, and quality context.

The Solution

Market Intelligence for Cost Containment

Actual Negotiated Rate Benchmarks
Ground employer reviews in observed commercial market rates rather than theoretical discounts.
Benchmark Support For Pricing Strategy
Use market medians, percentiles, and outlier detection by category and facility.
Provider Steerage Intelligence
Identify cost-effective, quality-aware pathways for common procedures.
Client Review Workflow
Save states, export benchmark slices, and package bookmarks plus saved views for account-team follow-up.
Outlier Detection
Flag facilities and categories that sit far above market and deserve analyst review.
Network Strategy for Employer Groups
Support custom network and tiering conversations for large employer clients.
Real-World Application

How TPAs Use Healthdex

Employer Benchmark Review

Scenario: A regional TPA needs a cleaner way to review hospital pricing, identify steerage opportunities, and present reusable evidence to employer clients.

Review hospital benchmark reports for above-market facilities.
Compare provider contributors and affiliated-hospital pathways.
Use imported quality summaries before escalating recommendations.
Assemble bookmarks and saved views into client packets.

Result: Employer conversations become faster and easier to repeat across markets and categories.

Imaging Steerage Program

Scenario: A TPA identifies imaging as a top cost driver and needs defensible market evidence for steerage design.

Compare imaging categories across facilities.
Identify lower-cost alternatives with acceptable context.
Review affiliated-hospital routing paths.
Export focused slices for client and member-program planning.

Result: The team can prioritize service families and facilities with evidence instead of working from broad discounts alone.

By The Numbers

Impact for TPA Clients

$1.8M
Avg Annual Savings Per Client
18-25%
RBP Savings vs. PPO
Saved
Views + Packets
Quality
Included In Hospital Review
Platform Capabilities

Built for Cost Containment Teams

Multi-Market Rate Data

Access negotiated rates across markets and export benchmark slices for employer review.

RBP Benchmark Tools

Use market medians, percentile rankings, and outlier detection for pricing strategy.

Provider Cost/Quality Rankings

Review better-value hospital pathways with benchmark and imported-quality context.

Workflow Persistence

Keep employer-specific work organized with saved views, bookmarks, and packets.

Hospital Quality Drilldown

Open imported-quality detail when a hospital comparison needs more than price position.

Cross-Market Comparison

Compare hospital or provider benchmark rows across geographies for multi-market employers.

Next Step

Ready to Prove ROI to Employer Clients?

Access real market benchmarks, compare affiliated-hospital pathways, and keep employer review workflows organized across categories and markets.

Request pilot access