New CMS price transparency rules have created a massive headache for hospitals looking to publish data often hidden in archaic systems and fragile spreadsheets, which is why Turquoise Health raised a $20M Series A round to help ease the pain and increase compliance.
The Turquoise platform allows provider organizations and payors to digitize their service catalogs and pricing information, creating what it calls a “pre-revenue cycle” where patients know costs upfront and providers receive quicker compensation.
- Although most of this data reaches care navigation platforms through an API, patients can also use a search engine on the Turquoise Health website to compare hospitals across all 50 states.
- Turquoise’s recent investment will be put to work developing the software needed to aggregate the wide range of inputs contributing to a procedure’s final cost, as well as determining health plan coverage at each step.
In anticipation of new payor rate disclosure requirements arriving in July, Turquoise also announced the launch of its Clear Contracts platform, which streamlines the direct contracting process with premade agreements generated from its pricing data.
- At launch, Clear Contracts will support single case agreements, retrospective out-of-network agreements, and group health agreements, with the boilerplate contracts allowing for a quicker back-and-forth during negotiations.
- a16z’s Julie Yoo called payor-provider contracts “the tail that wags the dog for most healthcare navigation decisions,” and Turquoise’s mission to modernize them was a key driver behind her decision to lead the Series A.
The Takeaway
Leveraging data from the Turquoise platform to support contract negotiations seems like a smart move for a company looking to build a business model around a valuable data asset. CMS transparency rules, the No Surprises Act, and the upcoming payor rate disclosure requirements have created a sea of regulations that’s extremely favorable for startups that can help navigate these waters, especially if they can translate their data into supporting services like Clear Contracts.
