Prescera works with benefits brokers, consultants, and employers to identify where outpatient price variation creates avoidable spend in self-funded health plans, understand what is driving it, and focus strategy on the actions that will have the greatest impact.
Claims data is complicated, pricing is opaque, and most standard reporting tells you what happened, not what to do about it. Prescera works on a deliberately narrow slice of the problem: outpatient services where pricing varies meaningfully across facilities, where care is typically scheduled in advance, and where shifts in site of care are unlikely to disrupt member access or provider relationships.
We look specifically at outpatient categories, primarily diagnostic imaging, but also outpatient procedures and ambulatory facilities, where pricing variation tends to be most pronounced and actionable.
We help plans understand how their spending compares: to themselves over time, to similar employers, and to the market, so that opportunity areas are grounded in something more than a single data point.
The analysis ends with a clear summary of where meaningful opportunity exists, what the tradeoffs look like, and what next steps are worth considering, sized to what's actually implementable.
Each review starts with a clearly defined pricing question and ends with a concrete set of findings and options. Not a dashboard to interpret on your own.
We start by listening. What question are you trying to answer? What has your client been asking about? What does their renewal look like? We tailor the scope to what's actually useful, not a standard package.
We do the analytical work: pulling pricing data, reviewing claims patterns, building comparisons, and identifying where the variance is widest and most addressable. You don't need to interpret a dashboard. We come back with findings.
We walk you through what we found, what it means for your client, and what's worth doing about it. Every recommendation comes with an honest assessment of tradeoffs, implementation complexity, and expected impact.
Start focused and expand only where there's a clear reason to go deeper. Pricing varies by employer size and scope.
Input: Metro area, target procedure category, primary payer, and employer size.
Output: Pricing variance analysis customized to a specific payer, market, and employer group, showing facility-level rate ranges with key findings and estimated addressable spend.
Timeline: 1-2 weeks. No claims data required.
Best for: Clients looking for a focused, actionable analysis before committing to a larger engagement.
Input: 12 months of de-identified claims data.
Output: Detailed findings report with ranked opportunities by category, facility-level spend breakdowns, savings estimates, and implementation options with tradeoff assessment.
Timeline: 3-4 weeks.
Best for: Self-funded groups ready to act on specific outpatient cost drivers.
Input: Updated claims data from the prior quarter.
Output: Summary of key metrics, trend comparisons against baseline, progress toward targets, and any recommended adjustments.
Timeline: Delivered within 2 weeks of data receipt, quarterly.
Best for: Clients that want to track spend trends, measure progress, and adjust strategy based on what the data shows over time.
Input: Varies by category. May use claims data, public pricing data, or both.
Output: Category-specific analysis following the same methodology. Areas include pharmacy spend, GLP-1 utilization, lab services, or telehealth gaps.
Timeline: Scoped and priced independently based on complexity.
Best for: Engagements where the initial review surfaces opportunities in adjacent categories.
MRI Pricing Variance in Minneapolis-St. Paul
This analysis examines negotiated MRI rates across four major commercial payers in the Twin Cities metro, covering 162 rates across 80 facilities. It quantifies the pricing gap between hospital outpatient departments, health system imaging centers, and freestanding facilities, and estimates the addressable overspend for a typical self-funded employer group.
This is a sample of the kind of market snapshot we provide. For a deeper look customized to your client's specific payer, market, and employee population, see our Market Analysis engagement.
Recent research, policy changes, and market developments relevant to employer-sponsored healthcare spend and outpatient care.
of every engagement fee is invested in organizations working on the conditions that drive poor health. 5% is directed by the client to a local organization of their choosing, in the communities where their employees live and work. The other 5% is directed by Prescera toward organizations addressing these issues at a broader scale.
Clinical care accounts for only 10-20% of modifiable contributors to health outcomes. The rest comes down to the conditions where people live and work: financial stability, housing, nutrition, access to transportation, and community support. These upstream conditions become downstream claims.
Prescera builds price transparency tools for small employers using public payer machine-readable file data, with a focus on outpatient services where facility-level prices vary meaningfully and the results can support practical benefits decisions.
The work draws on experience with large-scale provider, facility, pricing, and healthcare datasets, including analyses spanning tens of thousands of hospitals and hundreds of thousands of providers.
That background shapes how Prescera approaches each review: focused questions, transparent assumptions, practical exhibits, and clear next-step options that can support conversations with carriers, TPAs, brokers, benefits partners, and internal teams.
If you're a broker, consultant, or employer looking for a clearer picture of where outpatient pricing variation may be creating avoidable spend for your company or your clients, Prescera can prepare a complimentary market snapshot as a starting point. No claims data required.
Request a Market Snapshot