In December 2018, HEP III made an investment in Payer Compass, a provider of healthcare reimbursement and cost containment software and services.
Greg Everett, President and CEO, has spent over 26 years in managed care and healthcare software and brings extensive knowledge and experience to both provider and payer organizations. Greg is focused on charting a path for better and more affordable care through thought leadership, innovation, and collaboration.
Payer Compass prices 2.5 million claims per month using the company’s software platform, VISIUM, in order to service more than 130 customers. VISIUM manages claims for Medicare, Medicaid, commercial and reference-based pricing plans.
Why did you decide to launch Payer Compass?
Payer Compass is the story of an explorer, a thinker, and a believer. I was searching for alternatives to explain the cost of care that continued to become more opaque and less affordable. Roman Gekhter, our CIO, had an analytical tool unlike any other I had witnessed that provided a transparent, true cost of care. This tool would later be expanded and known as VISIUM™, our healthcare reimbursement and analytical platform. The actual company was formed in April of 2013.
VISIUM™ continues to be the hub of our technology solutions. It not only serves as the main engine for our pricing and auditing services, but it is also what makes us unique in the increasingly competitive reference-based pricing (RBP) marketplace. Our RBP solution, INNOVATE360, is an end-to-end program that stacks patient advocacy and strategic balance bill support on top of VISIUM’s pricing and analytics.
How does Payer Compass serve the healthcare market?
We provide pricing transparency and cost containment services that bridge the gap between payers and providers. Our tools and solutions address Medicare, Medicaid, Commercial, RBP and Dual healthcare claims for third-party administrators (TPAs), self-insured employers, brokers/benefit advisors, stop-loss carriers, health plans, PPOs, government entities, and Native American tribes.
Our products are a genuine reflection of our goal to deliver a better price for better care, accessible by as many people as possible. Our competitive offerings in the reimbursement marketplace include healthcare claim pricing and edit application, modeling and analytics, a turnkey RBP program, balance bill and appeals support, patient advocacy, bundled payments, URAC-accredited care management, and patient-centric workflow management.
Payer Compass’ offerings support our clients’ efforts to optimize plan selection and maximize both healthcare claim and plan savings, averaging between 30% and 40% more than traditional PPO networks. We continue to expand our presence in the health plan market space, providing reimbursement to carriers that need our complex set of health edits and reimbursement algorithms to calculate state Medicaid programs and Medicare Advantage plans.
As a leader in the RBP space, we can save clients 63%, on average, and often much more, all while reducing balance bills to a mere 1% or less. Our RBP footprint consists of more than 125 TPA partners and nearly 1,000 employer groups representing two million covered people.
Where do you see the company going over the next few years?
While the Affordable Care Act has ensured that everyone can get health insurance, it has not solved the mounting cost problem in our country. Employers are struggling to balance the provision of health benefits to employees with the challenge of reducing or flattening the company’s overall program costs.
Payer Compass will strengthen its position as an innovator in the healthcare reimbursement space with employer-sponsored healthcare while broadening a more extensive use of its VISIUM™ toolset within the government sector business to help rein in healthcare costs for state and federal programs.
How would you describe the culture of Payer Compass?
Our people are at the heart of our organization. We have an impressive team of bright, diligent individuals who seem to truly respect one another and connect on a more personal level, beyond the day-to-day operations. The team members themselves lead several events and activities selected to appeal to different interests. They do everything from serving local nursing homes and underprivileged children at The Birthday Party Project, to coming together for a funny YouTube video-watching lunch, or a little friendly competition in our chili cook-off. There is definitely a strong sense of team here that we will consciously work to preserve as we grow.
What occupies your free time?
Outside of Payer Compass, my wife and I enjoy a variety of travel across the country from the beaches in Florida to Broadway in New York to the vineyards of California. It sounds a bit corny but America is a special place, and its beauty is both in our people and its land.