Frequently Asked Questions

About MacroHealth 

• What is MacroHealth’s mission and vision for the healthcare industry?

  MacroHealth’s mission is to make the buying and selling of healthcare simple and powerful. By bringing transformational intelligence to healthcare, MacroHealth enables more efficient and effective collaboration between healthcare Payers and Health Market Partners.

  7.2M+

  commercial members served

  6-8%

  reduction in the total cost of care

  300+

  enterprise clients

  45+

  Health Market Partners

About Intelligent Health Markets

• How does MacroHealth define an Intelligent Health Market, and why is it important?

  An Intelligent Health Market is a connected ecosystem where Payers and Health Market Partners, such as provider and specialty networks, pharmacy benefit managers, specialty pharmacy benefit managers, and others, collaborate seamlessly using data-driven insights to optimize cost management and resource allocation.   
   
  This model is crucial because it replaces traditionally fragmented systems with a streamlined, transparent, and collaborative approach. The result is enhanced operational efficiency, the ability to identify cost-saving opportunities, and improved outcomes for all stakeholders.  

• What are the key components of an Intelligent Health Market?

  An Intelligent Health Market is built around two key components that are crucial for Payers:  

  1. Optimized Ecosystem: Payers can design and manage a customized ecosystem of vendors, including provider and specialty networks, pharmacy benefit managers, digital health vendors, and more. Using data-driven insights, Payers can identify the most effective and cost-efficient combinations for their unique member populations. 
  2. Connected Infrastructure: A single platform allows seamless connectivity across all partners in the healthcare marketplace. This eliminates the need for multiple, inefficient point-to-point integrations and enables interoperability. With this connected infrastructure, Payers gain a holistic view of their ecosystem, enabling better-informed, strategic decisions.

  These components work together to create a more efficient, transparent, and collaborative healthcare marketplace. 

• What benefits can Payers expect from leveraging an Intelligent Health Market?

  Payers can expect several key benefits from leveraging an Intelligent Health Market: 

  1. Cost Optimization: Utilize performance data from Health Market Partners to identify cost-saving opportunities and optimize healthcare spending.  
  2. Improved Efficiency: Streamline operations by integrating all Health Market Partners through a single platform, reducing administrative complexity.  
  3. Better Decision-Making: Access intelligent insights to make informed, timely decisions tailored to unique member populations.  
  4. Greater Transparency: Gain clear visibility into costs, performance, and available solutions, enhancing decision-making and value.  
  5. Scalability and Flexibility: Easily scale and adapt the ecosystem to meet evolving market demands and member needs.  

About the MacroHealth Intelligent Exchange^™ Platform

• What types of data and analytics does the MacroHealth Intelligent Exchange (MiX) platform provide to Payers?

  The MiX platform provides Payers with actionable data and analytics to optimize their healthcare ecosystems. Through its Data Factory, which integrates Payer data, third-party data, (like CMS and MRF data), and MacroHealth’s proprietary insights, the platform enables Payers to:   

  • Evaluate Network Performance: Assess metrics of Health Market Partners to identify the most effective solutions for their member populations.  
  • Identify Cost-Saving Opportunities: Surface insights that help Payers pinpoint areas to reduce spending without sacrificing value.  
  • Track Ecosystem Performance: Continuously monitor the performance of their healthcare ecosystem to ensure alignment with organizational goals and member needs.   

The Benefits of Partnering with MacroHealth

• How can MacroHealth help Payers reduce administrative complexity and streamline operations?

  MacroHealth simplifies processes such as network management and data analysis into one intuitive platform. This eliminates redundant systems and reduces the administrative burden on Payers. 

  “Through our collaboration with MacroHealth, we’ve seen significant reductions to the level of effort needed to operationalize and connect to network and pricing solutions.”

  Brad GarriguesChief Growth Officer, Providence Health Plan

• How does MacroHealth ensure compliance with Payer-specific regulations and requirements in the healthcare market?

  Adhering to evolving regulations is more important than ever in this new era of transparency. MacroHealth’s platform is designed with compliance in mind, incorporating regulatory requirements and industry standards into its operations. The system’s transparency and reporting features ensure that Payers can meet regulatory obligations while maintaining high standards of efficiency and accountability.