Transparent Health Marketplace to disrupt workers' compensation

Transparent Health Marketplace to disrupt workers' compensation | Insurance Business

Transparent Health Marketplace to disrupt workers

There’s a new kid on the block making waves in the workers’ compensation space. Think eBay but for healthcare, the Transparent Health Marketplace (THM) is a digital marketplace that directly connects payors and providers of workers’ compensation healthcare services in an open platform featuring market-driven, point-in-time pricing.

THM replaces outmoded network contract models with an innovative digital marketplace approach. It combines automated billing, payments and scheduling to deliver cost savings and efficiencies for payors, while also providing growth opportunities and contract certainty for healthcare service providers. The marketplace recently completed a Series B Preferred Stock round of approximately $11 million, which will be used to support the official launch of the THM platform.

“The THM virtual marketplace model delivers the kind of innovation that is long overdue in workers’ compensation,” said Jim Mayhall, president of THM. “We’re bringing technology that’s been used in auction-type models, such as eBay, or other sites where you’re pushing out opportunities for providers of services. In THM’s case, the providers of services are physicians in the workers’ compensation marketplace that are providing physical therapy and diagnostic services to start off with.

“We are providing a pricing platform where they can name a standing bid price for services of physical therapy and diagnostics. It revolutionizes the current model of contracting with payors in the workers’ compensation marketplace, because providers put their price up front and then they allow us through the marketplace engine to source members for them. It’s a two-sided market. We’re bringing payers to the marketplace that have workers’ compensation employees, and we’re bringing the providers that treat those employees in one consolidated solution.”

THM has the ability to fix many pain points in workers’ compensation, according to Mayhall. First and foremost, it replaces what Mayhall describes as “outmoded network contract models,” which can be quite laborious and time-consuming, especially if providers have to chase up payment for services on the back end.

“We’re trying to alleviate a lot of the pain chase that goes on where there’s a lot of different players in the ecosystem. When these players take unnecessary mark ups, there are a lot of hidden fees along the way,” Mayhall told Insurance Business. “We want THM to be a transparent marketplace so we can upfront identify for the employers or the payors that are bringing in their employees to the marketplace exactly what they’re going to pay. They won’t have a pricing loop that gets convoluted and nobody knows what the true cost is. And then we’re not holding payment on these providers; we’re actually providing payment within 30 days, versus sometimes being held for 45 days, 90 days or longer.”

Payors that choose to use THM maintain the power of choice. They’re simply made aware of the providers that are available, their location, the type of procedure, the price, and the dates at which each provider is willing and available to perform the service. This enables providers to compete on price, while also giving payors access to multiple options.

“Hopefully that starts to smooth out price variation, and brings better scheduling opportunities,” Mayhall commented. “In workers’ compensation, you want to avoid the litigation and indemnification-type costs that happen if a member is floating out in the wind with no access to care. It’s our goal to help get injured workers in the diagnostic imaging center as quickly as possible to figure out what’s wrong with them, and then get them physical therapy treatment so they can get back to work as soon as possible.”

THM has launched in pilot mode in several states. It has proven its technology platform with one of the nation’s largest payor organizations. It’s latest $11 million funding round will allow for the expansion of staff while providing a foundation for THM to advance its marketplace platform capabilities.