Improve your rules.
Based on what actually happened.
Audits explain what went wrong. Monitoring prevents repeat errors. Optimization uses verified historical data to improve how benefit and contract logic is written going forward.
Rules are rarely designed with real usage in mind.
Logic gets added but rarely removed. Thresholds drift from their original intent.
These patterns are invisible in aggregate reporting.
Optimization requires more than intuition. it requires verified evidence.
Why optimization is hard without verified data.
Teams have experience, data, and tools. But optimization decisions still rely on incomplete information about how rules actually behave.
What it does
Expert judgment on select rules
The gap
Can't cover hundreds of rule interactions
What it does
Spend forecasts and trend reports
The gap
Shows outcomes, not why rules fired
What it does
Threshold adjustments on paper
The gap
Unintended consequences appear at scale
Optimization works best when you know exactly how rules behave. not just what outcomes look like.
From contract terms to bottom-line impact.
We tie every clause in your contracts to real historical usage, so you can see exactly what drives cost, test changes safely, and optimize for the outcomes you want.
Map clauses to impact
See exactly which contract terms drive cost. Every clause is tied to historical claims and quantified.
§3.1Rate Escalator (Hospital)§7.3Carve-out Threshold (Hospital)Exh BNetwork Discount (Self-Funded)§4.1Stop-loss Specific (Self-Funded)App AAttribution Logic (VBC)§9.2Volume Bonus (Hospital)Test changes before deploying
Run what-if scenarios to see how specific changes would have affected outcomes, including side effects.
§3.1 Rate Escalator:3% annualCPI-U linkedOptimize for your goals
Define your constraints and objectives. The solver finds the optimal configuration across all your rules.
The hidden costs inside your logic.
Most contract and benefit logic accumulates inefficiencies over time. These patterns show up clearly when you analyze verified rule behavior.
What you get from optimization.
Every recommendation is backed by data that has already been verified against the rules.
The decisions you're already making.
Now with verified data.
These moments happen every year. Walk in with evidence, not assumptions.
Enter negotiations with documented evidence
Hospital going into renewal with documented escalator drift, fee schedule errors, and unused clauses as concrete leverage.
Model changes against real claims
Self-funded employer modeling new stop-loss thresholds and Rx formulary changes against historical claims data.
Trace settlement gaps to root cause
VBC organization tracing a settlement gap to stale benchmark methodology and attribution errors, with 60-day dispute window.
Test policy changes before they go live
Payer testing prior auth tightening and modifier rule updates against historical claims to predict downstream effects.
One question.
Verified answer.
Pick a contract term or benefit rule. We'll show you exactly how it performed, and what would change if you adjusted it.
See how this applies to you