Phase 01
Price Discovery
We analyze claims against published hospital pricing files to identify what the plan paid, what comparable cash-pay rates show, and where meaningful variation exists.
Healthcare Price Intelligence · Self-Funded Employers
Self-funded employers are often paying more through PPO contracts than hospitals publish as cash rates.
Openbook Health helps plan sponsors identify healthcare overpayment and act on it using claims analysis, published hospital pricing data, and direct contracting strategy.
590%
Sample PPO rate vs. Medicare
for outpatient surgery
for outpatient surgery
$1.58M
Projected annual savings identified
for a 2,000-life plan
for a 2,000-life plan
271%
Published cash-pay benchmark
vs. Medicare baseline
vs. Medicare baseline
The Problem
Negotiated rates do not necessarily mean better rates.
Many self-funded employers assume their PPO contract protects them from overpaying. In practice, published hospital pricing can reveal the opposite: reimbursement may exceed available cash-pay or direct-contracting benchmarks by a wide margin.
Openbook turns public pricing data and claims data into decision-ready intelligence before renewal, repricing, provider negotiation, or targeted steerage.
590%
Illustrative outpatient surgery reimbursement at 590% of Medicare under a conventional PPO contract.
Illustrative rate comparison — outpatient surgery
Based on an Openbook analysis framework for a 2,000-covered-life self-funded plan.
How It Works
From claims data to actionable savings strategy.
Three steps. Defensible numbers. Clear next actions.
Phase 02
Gap Analysis
We quantify overpayment at the procedure, facility, and service-line level and translate that variance into estimated dollar impact and prioritized opportunity areas.
Phase 03
Action Strategy
We develop a targeted strategy that can include renewal leverage, provider negotiation, steerage, cash-pay pilots, direct contracting, and fiduciary-ready decision support.
Results
What published pricing data revealed.
Each engagement is built around auditable findings tied to real plan spend and published provider pricing.
Outpatient surgery
Validated cash-pay comparisons surfaced material savings opportunity across shoppable procedures.
−54%
Sleep studies
High-volume utilization with meaningful reimbursement spread relative to published benchmarks.
−61%
MS-DRG restructure
Inpatient direct-contracting benchmarks materially below legacy PPO reimbursement patterns.
−46%
Who We Serve
Built for stakeholders accountable for healthcare spend.
Openbook is designed for organizations and partners that bear real claims risk or need sharper procedure-level price intelligence.
Self-Funded Employers
Procedure-level price intelligence to support cost containment, provider negotiation, benefits strategy, and fiduciary oversight.
- Plan sponsor decision support
- Renewal and repricing leverage
- Targeted steerage opportunities
Benefits Advisors & Consultants
Published pricing analysis that helps bring clients clearer numbers, better renewal strategy, and more defensible recommendations.
- Client-specific savings narratives
- White-label analysis support
- Sharper employer conversations
Stop-Loss & Captive Partners
Procedure-level pricing intelligence to improve visibility into cost variation, exposure, and disciplined cost-containment strategy.
- Benchmarking support
- Risk-aware purchasing strategy
- High-cost procedure visibility
About
Why Openbook exists.
Openbook Health was built around a simple but important discovery: self-funded employers can be systematically overpaying for care even when purchasing through traditional PPO networks.
Using claims data and federally required hospital pricing disclosures, Openbook helps employers identify where that overpayment exists, how large it is, and what actions may be available in response.
Our work sits at the intersection of price transparency, employer healthcare strategy, direct contracting, and fiduciary decision-making. The goal is not more raw data. The goal is better purchasing decisions.
Get Started
See whether your plan is overpaying.
For qualifying self-funded employers, Openbook provides an initial review of high-spend procedures against published hospital pricing data to identify potential savings opportunity.
SOUTH FLORIDA BASED · SERVING SELF-FUNDED EMPLOYERS NATIONALLY