Gigasheet and Kaelio: Empowering Providers with Data for Smarter Payer Contract Negotiations

Providers have long been at an information disadvantage when negotiating contracts with insurance payers. Limited to their own billing and claims data, hospitals and physician groups have historically lacked the market-wide insights that payers possess. This information asymmetry has often resulted in unfavorable reimbursement rates and a struggle to secure fair compensation for the services they provide. However, recent advancements in data transparency and analytics are leveling the playing field, and the partnership between Gigasheet and Kaelio is at the forefront of this transformation.

The Challenge: Negotiating in the Dark

For years, payer contract negotiations have been a one-sided affair. Payers had a "black box" view of market rates, while providers were left to rely on historical data, anecdotal evidence, and expensive consultants. As one industry analysis noted, physicians were historically “hamstrung in negotiations because they don’t have data to back up their assertions that payers are under-paying them.” This lack of data-driven leverage has led to wide and often unfair variations in reimbursement rates across the industry.

Price Transparency: A New Era of Data-Driven Negotiations

The recent implementation of federal price transparency regulations has been a game-changer. The Hospital Price Transparency rule and the Transparency in Coverage (TiC) rule have made detailed contracted prices between payers and providers publicly available for the first time. This wealth of information, in theory, allows providers to benchmark their rates against competitors and negotiate from a position of strength. However, the raw data files are massive, complex, and difficult to analyze without specialized tools.

Kaelio: Unlocking Insights from Internal Data

This is where Kaelio, a Y Combinator-backed healthcare data intelligence platform, comes in. Kaelio acts as an AI-powered copilot for provider organizations, unifying all of a hospital’s internal data, including electronic health records, financial systems, and third-party data sources, into a single analytics-ready source. By harmonizing previously siloed data and allowing administrators to leverage it without relying on a data team, Kaelio provides a comprehensive and up-to-date view of an organization’s performance, enabling leaders to identify trends, anomalies, and opportunities for improvement.

With Kaelio, a hospital can quickly identify which payers have the highest denial rates, how reimbursement trends for specific procedures have changed over time, and where the biggest revenue opportunities lie. This internal clarity is the first half of the equation for data-driven negotiations. 

Gigasheet: Bringing Market Price Transparency to the Forefront

The second half of the equation is Gigasheet’s price transparency solution. Gigasheet is a no-code big data platform that specializes in processing the enormous price transparency files and presenting them in a familiar, spreadsheet-like interface. With Gigasheet, providers can explore and compare negotiated rates side-by-side across payers and competitors, turning terabytes of messy payer data into clean, comparable rate insights on demand.

Gigasheet’s platform allows users to benchmark their negotiated rates against competitors, identify underpayments by payer or region, and flag outliers. This empowers providers to enter negotiations with hard facts about what other providers are being paid for the same services. To explore how Gigasheet can help you leverage this data, check out our price transparency solutions for providers.

A Powerful Partnership: Combining Internal and External Data for Maximum Leverage

The partnership between Gigasheet and Kaelio creates a 360-degree data-driven negotiation strategy. By integrating Kaelio’s internal claims and finance analytics with Gigasheet’s external price transparency data, providers can get the full picture needed to negotiate contracts confidently and successfully. This powerful combination enables providers to:

• Identify Underpayments: Compare internal reimbursement data with external market rates to pinpoint where they are being underpaid.
• Benchmark Against Competitors: See how their rates stack up against other providers in their market.
• Negotiate from a Position of Strength: Enter negotiations armed with irrefutable data to support their requests for fairer reimbursement.
  
  

This combined approach instills confidence and empowers providers to prioritize their negotiation efforts where the data shows the biggest upside. As negotiations become more fact-based, the process becomes more efficient and effective for both providers and payers.

Empowering Providers in a New Era of Transparency

The synergy between Gigasheet and Kaelio exemplifies how technology can lower the barrier to working with big data, and convert raw information into real-world value. By joining forces, we are helping provider organizations secure sustainable, competitive reimbursement rates that reflect the quality and value of the care they deliver. Together Gigasheet and Kaelio provide tools for effective contract negotiations and market intelligence improving healthcare organizations' financial stability.