{"id":37598,"date":"2025-07-10T09:17:09","date_gmt":"2025-07-10T09:17:09","guid":{"rendered":""},"modified":"-0001-11-30T00:00:00","modified_gmt":"-0001-11-30T00:00:00","slug":"how-innovative-partnerships-can-drive-surgical-cost-transparency-and-improve-quality-of-care-1807875","status":"publish","type":"post","link":"https:\/\/www.simbo.ai\/blog\/how-innovative-partnerships-can-drive-surgical-cost-transparency-and-improve-quality-of-care-1807875\/","title":{"rendered":"How Innovative Partnerships Can Drive Surgical Cost Transparency and Improve Quality of Care"},"content":{"rendered":"<p>Surgical care is complicated and costly. Different hospitals and doctors often charge very different amounts for the same procedure. Billing practices are not always clear. Many providers and facilities are involved, which makes it hard for payors, employers, and patients to know the costs before surgery. This can cause surprise bills and higher out-of-pocket costs for patients. It may also reduce patient satisfaction.<\/p>\n<p><\/p>\n<p>For healthcare administrators and IT workers running the practices, the lack of clear cost data makes it harder to negotiate contracts with payors and providers. When prices are unclear, it is tougher to design fair benefit plans or guide patients to cost-effective providers without lowering care quality.<\/p>\n<p><\/p>\n<h2>How Partnerships Address Surgical Cost Transparency<\/h2>\n<p>Companies like Claritev and Lantern work together to make surgical costs clearer and improve care quality. Claritev is a healthcare technology and data company with over 40 years of experience in claims repricing. It has platforms called BenInsights\u00ae and HST Connect\u00ae that mix clinical data with financial claims to show health spending patterns clearly.<\/p>\n<p><\/p>\n<p>Lantern focuses on lowering specialty care costs and improving quality. It has a Network of Excellence and uses a method called TrueRate\u2122 to standardize pricing and save money. Together, Claritev and Lantern help healthcare groups find where they can reduce surgery costs without hurting patient results.<\/p>\n<p><\/p>\n<p>Claritev processes 25 million medical claims each month and looks at $168 billion in medical charges every year. From this, they find about $22 billion in savings for payors. They also help remove balance bills from over 10.5 million claims annually, cutting down on unexpected patient costs.<\/p>\n<p><\/p>\n<p>Lantern adds a network of qualified surgical specialists and uses TrueRate\u2122 to keep pricing clear and reliable. Both companies offer platforms that give medical practice administrators tools such as:<\/p>\n<ul>\n<li>Reports that combine clinical and financial data to study surgical cost differences.<\/li>\n<li>Patient steering tools that help direct patients to providers who offer better care at lower costs.<\/li>\n<li>Insights to help design better insurance plans and networks, cutting unneeded expenses.<\/li>\n<li>Strategies to negotiate fair reimbursement for out-of-network claims and prevent wrong billing.<\/li>\n<\/ul>\n<p>This method helps make care more affordable and improves patient experiences and care coordination.<\/p>\n<p>\n<!--smbadstart--><\/p>\n<div class=\"ad-widget case-study-ad\" smbdta=\"smbadid:sc_26;nm:UneQU319I;score:0.68;kw:urgent-referral_0.99_specialist-rout_0.94_queue-bypass_0.88_response-speed_0.73_care-coordination_0.68;\">\n<h4>Voice AI Agent Accelerates Urgent Referrals<\/h4>\n<p>SimboConnect AI Phone Agent routes specialist calls past queues &#8211; 2x faster response.<\/p>\n<div class=\"client-info\">\n    <!--<span><\/span>--><br \/>\n    <a href=\"https:\/\/simbo.ai\/schedule-connect\">Connect With Us Now \u2192<\/a>\n  <\/div>\n<\/div>\n<p><!--smbadend--><\/p>\n<h2>Impact on Medical Practices and Employer Groups<\/h2>\n<p>Claritev works with over 700 healthcare payors, supports more than 100,000 employers, and indirectly affects 60 million people across the U.S. Its network has 1.4 million contracted providers, allowing it to manage care decisions and costs well.<\/p>\n<p><\/p>\n<p>For medical practice administrators, access to this data leads to better contract talks. Knowing where costs are high or low helps practices improve their provider networks or adjust services to match payors\u2019 preferred providers or bundled payment models.<\/p>\n<p><\/p>\n<p>Employers also benefit since they pay for many surgical costs through health plans. Better cost transparency helps them manage health budgets and set clear cost expectations for employees. It also supports efforts to decrease unnecessary care and surprise bills, improving satisfaction.<\/p>\n<p><\/p>\n<p>Lantern\u2019s Network of Excellence makes sure patients get expert care near their homes. Dedicated care teams, including nurses and care advocates, help patients through the complex surgery process. This mix of clear costs and good care meets the needs of today\u2019s patients for both clarity and access.<\/p>\n<p><\/p>\n<h2>Other Industry Collaborations Driving Surgical Innovation<\/h2>\n<p>Besides Claritev and Lantern, other healthcare groups are working together to improve surgery.<\/p>\n<p><\/p>\n<p>Caresyntax, a company that focuses on surgical intelligence and automation, has joined with Pristine Surgical. Pristine makes single-use digital endoscopes and cloud-based surgical tools. They gather real-world data from orthopedic surgeries done mostly in outpatient centers.<\/p>\n<p><\/p>\n<p>Their platforms analyze financial data plus clinical results, device use, and surgery workflow data. Their goal is to improve efficiency, cut surgical costs, and raise patient results by giving useful information before, during, and after surgery. Using AI analytics in real time helps hospitals measure surgery quality and safety more clearly.<\/p>\n<p><\/p>\n<p>This shows that managing surgery costs is not just about prices. It also involves better operations and improved clinical workflows.<\/p>\n<p>\n<!--smbadstart--><\/p>\n<div class=\"ad-widget checklist-ad\" smbdta=\"smbadid:sc_28;nm:AOPWner28;score:0.89;kw:holiday-mode_0.95_workflow_0.89_closure-handle_0.82;\">\n<div class=\"check-icon\">\u2713<\/div>\n<div>\n<h4>AI Phone Agents for After-hours and Holidays<\/h4>\n<p>SimboConnect AI Phone Agent auto-switches to after-hours workflows during closures.<\/p>\n<p>    <a href=\"https:\/\/simbo.ai\/schedule-connect\" class=\"download-btn\"> Connect With Us Now <\/a>\n  <\/div>\n<\/div>\n<p><!--smbadend--><\/p>\n<h2>Technology and AI in Surgical Cost Management and Workflow Automation<\/h2>\n<h2>AI-Driven Analytics for Cost and Quality<\/h2>\n<p>Artificial intelligence (AI) is important for improving surgical cost transparency. AI can study large amounts of claims, billing, clinical notes, and patient outcomes. It finds patterns like unnecessary tests, overcharging, or poor care paths.<\/p>\n<p><\/p>\n<p>Claritev\u2019s platform uses data scientists with over 40 years of claims experience to spot wrong billing and find savings. AI can quickly process millions of claims every month while giving deep insights into cost differences and patient outcomes. This helps payors and employers make smart decisions to control costs without hurting care quality.<\/p>\n<p><\/p>\n<p>AI tools also create clear visual reports, like Claritev\u2019s BenInsights. These reports show administrators an easy-to-understand view that helps with negotiations, building networks, and designing benefit plans by showing where savings and quality improvements can happen.<\/p>\n<p><\/p>\n<h2>Workflow Automations to Reduce Administrative Burden<\/h2>\n<p>Automation helps by making administrative tasks simpler in surgical care. For example:<\/p>\n<ul>\n<li>Automated phone and front-office systems handle routine patient calls, scheduling, and billing questions. This cuts costs and lets staff focus on harder care tasks.<\/li>\n<li>Electronic data sharing improves information exchange between payors, providers, and patients. It follows federal rules like the ONC Cures Act and CMS Interoperability.<\/li>\n<li>AI decision support guides providers at the point of care. It suggests cost-effective, high-quality surgery options based on evidence and prices.<\/li>\n<li>Digital patient navigation tools, like those in Lantern\u2019s platform, give personalized care plans and help patients move smoothly through surgery stages, improving satisfaction and results.<\/li>\n<\/ul>\n<p>These automation tools are important as healthcare faces staff shortages and more patients. They help keep operations running well and support new care models that need precise cost and quality tracking.<\/p>\n<p>\n<!--smbadstart--><\/p>\n<div class=\"ad-widget regular-ad\" smbdta=\"smbadid:sc_4;nm:AJerNW453;score:0.85;kw:phone-tag_0.98_routine-call_0.92_staff-focus_0.85_complex-need_0.77_call-handling_0.42;\">\n<h4>Voice AI Agents Frees Staff From Phone Tag<\/h4>\n<p>SimboConnect AI Phone Agent handles 70% of routine calls so staff focus on complex needs.<\/p>\n<p>  <a href=\"https:\/\/simbo.ai\/schedule-connect\" class=\"cta-button\">Let\u2019s Chat \u2192<\/a>\n<\/div>\n<p><!--smbadend--><\/p>\n<h2>The Role of Strategic Partnerships in Driving Industry Change<\/h2>\n<p>Working together is key to solving ongoing issues with surgery cost and quality. The U.S. healthcare system is complex and needs experts from technology, providers, payors, and employers to cooperate.<\/p>\n<p><\/p>\n<p>Claritev\u2019s tech skills combined with Lantern\u2019s clinical network create a strong model that covers many parts of the surgery cost problem. Their shared focus on transparency gives consumers and payors better information and helps providers give value-based care.<\/p>\n<p><\/p>\n<p>Other partnerships, like between EmsanaRx (a pharmacy benefit manager) and Cleveland Clinic, show that teamwork can improve insurance programs beyond just surgery.<\/p>\n<p><\/p>\n<p>Google Cloud\u2019s work to link electronic health records (EHRs) with AI speeds up data use and shows the importance of cloud partnerships in healthcare IT. Highmark\u2019s myHighmark platform uses interoperability to give millions easy digital access to care help, bill payment, and cost info.<\/p>\n<p><\/p>\n<p>These examples show that combining technology, healthcare knowledge, and operational skills meets the need for affordable, clear, and quality care.<\/p>\n<p><\/p>\n<h2>Implications for Medical Practice Administrators, Owners, and IT Managers<\/h2>\n<p>Medical practice administrators and facility owners should understand these partnerships and new technologies. Clear surgical cost data helps with better payor negotiations and decisions about referrals and networks.<\/p>\n<p><\/p>\n<p>IT managers need to plan for integrating AI analytics and automation into current systems. This reduces manual work and improves data accuracy. Linking claims processing and interoperability tools will be key to working well with new reimbursement and reporting methods.<\/p>\n<p><\/p>\n<p>Practices should also use patient tools like digital care navigation, appointment automation, and billing portals to raise patient satisfaction and safety.<\/p>\n<p><\/p>\n<h2>Summary of Key Figures and Trends<\/h2>\n<ul>\n<li>Surgery makes up about 20% of an employer\u2019s total health spending but has often had unclear pricing.<\/li>\n<li>Claritev analyzes $168 billion in medical charges yearly and handles 25 million claims monthly, finding $22 billion in possible savings.<\/li>\n<li>Claritev supports over 700 payors, 100,000 employers, 60 million consumers, and works with 1.4 million providers.<\/li>\n<li>Lantern\u2019s Network of Excellence serves more than 6 million members across the country, focusing on specialty areas like surgery, cancer, and infusions.<\/li>\n<li>Partnerships that combine data analytics and clinical networks give detailed insights to reduce cost differences and improve surgical care quality.<\/li>\n<li>AI and automation help find savings, make workflows easier, and improve patient engagement.<\/li>\n<li>Regulations promote sharing clinical and claims data securely, supporting these advances.<\/li>\n<li>Partnership models go beyond surgery, including pharmacy benefit transparency and hospital IT upgrades.<\/li>\n<\/ul>\n<p><\/p>\n<p>This combined focus on cost clarity, clinical quality, and workflow efficiency using partnerships and AI offers a practical way to improve surgical care management in medical practices and health systems across the United States.<\/p>\n<section class=\"faq-section\">\n<h2 class=\"section-title\">Frequently Asked Questions<\/h2>\n<div class=\"faq-container\">\n<details>\n<summary>What is Claritev?<\/summary>\n<div class=\"faq-content\">\n<p>Claritev, formerly MultiPlan, is a healthcare technology and data insights company focused on improving affordability, transparency, and quality in the U.S. healthcare system.<\/p>\n<\/p><\/div>\n<\/details>\n<details>\n<summary>What services does Claritev provide?<\/summary>\n<div class=\"faq-content\">\n<p>Claritev offers tech-enabled solutions for various stakeholders, utilizing data analytics to drive affordability, price transparency, optimize networks, and enhance benefit plan design.<\/p>\n<\/p><\/div>\n<\/details>\n<details>\n<summary>How much medical charges does Claritev analyze?<\/summary>\n<div class=\"faq-content\">\n<p>Claritev analyzes $168 billion in medical charges annually to identify cost reduction opportunities.<\/p>\n<\/p><\/div>\n<\/details>\n<details>\n<summary>What potential savings does Claritev identify for payors?<\/summary>\n<div class=\"faq-content\">\n<p>Claritev identifies $22 billion in potential savings for payors through their analytics.<\/p>\n<\/p><\/div>\n<\/details>\n<details>\n<summary>How many medical claims does Claritev process each month?<\/summary>\n<div class=\"faq-content\">\n<p>Claritev processes 25 million medical claims every month.<\/p>\n<\/p><\/div>\n<\/details>\n<details>\n<summary>What issue does Claritev help eliminate for plan members?<\/summary>\n<div class=\"faq-content\">\n<p>Claritev has successfully eliminated balance bills on 10.5 million claims for plan members.<\/p>\n<\/p><\/div>\n<\/details>\n<details>\n<summary>What are some ways Claritev assists the healthcare industry?<\/summary>\n<div class=\"faq-content\">\n<p>Claritev helps negotiate fair reimbursements for out-of-network claims, provides actionable data, builds custom provider networks, and prevents improper billing.<\/p>\n<\/p><\/div>\n<\/details>\n<details>\n<summary>What is the purpose of the strategic partnership with Lantern?<\/summary>\n<div class=\"faq-content\">\n<p>The partnership aims to enhance surgical cost transparency and improve care quality, ultimately lowering costs in the healthcare ecosystem.<\/p>\n<\/p><\/div>\n<\/details>\n<details>\n<summary>What expertise does Claritev leverage?<\/summary>\n<div class=\"faq-content\">\n<p>Claritev utilizes vast domain knowledge, a team of data scientists, and significant investments supported by IT professionals to maximize medical savings.<\/p>\n<\/p><\/div>\n<\/details>\n<details>\n<summary>What legacy does Claritev have in the healthcare sector?<\/summary>\n<div class=\"faq-content\">\n<p>Claritev boasts a legacy of over 40 years in the industry, backed by numerous trusted relationships and extensive experience.<\/p>\n<\/p><\/div>\n<\/details><\/div>\n<\/section>\n","protected":false},"excerpt":{"rendered":"<p>Surgical care is complicated and costly. Different hospitals and doctors often charge very different amounts for the same procedure. Billing practices are not always clear. Many providers and facilities are involved, which makes it hard for payors, employers, and patients to know the costs before surgery. This can cause surprise bills and higher out-of-pocket costs [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-37598","post","type-post","status-publish","format-standard","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.simbo.ai\/blog\/wp-json\/wp\/v2\/posts\/37598","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.simbo.ai\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.simbo.ai\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.simbo.ai\/blog\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.simbo.ai\/blog\/wp-json\/wp\/v2\/comments?post=37598"}],"version-history":[{"count":0,"href":"https:\/\/www.simbo.ai\/blog\/wp-json\/wp\/v2\/posts\/37598\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.simbo.ai\/blog\/wp-json\/wp\/v2\/media?parent=37598"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.simbo.ai\/blog\/wp-json\/wp\/v2\/categories?post=37598"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.simbo.ai\/blog\/wp-json\/wp\/v2\/tags?post=37598"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}