San Diego startup Turquoise Health is harnessing the power of generative AI to simplify access to healthcare price transparency data. The burgeoning software company believes that people have a right to know the cost of care.
VP of Operations
Turquoise Health
“At the end of the day, our goal is to eliminate that financial complexity and make buying and paying for healthcare just like everything else in the world where you know the price upfront and you can actually shop around,” said VP of Operations Marcus Dorstel.
For an annual subscription, Turquoise Health grants providers – like hospitals – and payers – like insurance companies – access to relevant data to benchmark themselves against competitors during contract negotiations. “For instance, a health system that’s about to go into contract negotiations with a payer would use this data to see how their rates compare to other hospitals and how the payer might have contracted with hospitals in the area, and the payer would do the same looking at other payer rates,” said Dorstel.
He and the team have successfully sifted through countless databases to provide users with valuable comparisons, but it comes at a cost. The administrative burden is the next hurdle they’re looking to overcome. They think generative AI is the answer. They’re now actively using the technology to process large amounts of healthcare documents like PDFs and Excel spreadsheets – an otherwise tedious and time-consuming task.
“We’ve been starting to build AI into our products,” Dorstel added. “We can use AI to make our data more usable – especially contract data. There are contracts that providers and payers have that define the rates and how the rates get applied and how the claims need to be submitted or appealed. We’re building tools and products that can make sense of all of that in a quick and easy way.”
Specifically, Turquoise Health is using an enterprise-level protected ecosystem of OpenAI. “The basic process is to break the documents up into pieces and then ‘embed’ the documents by passing them through a model that represents the meaning of each piece as a number,” he explained. “We store those numbers in a vector database. Then to answer questions, we pull the pieces most similar to the topic of the question and ask OpenAI to answer the question based on these references. Then we can point the user back to the references used to answer the question.”
The company garnered added attention after the April release of its 2023 Price Transparency Impact Report, which analyzes data reported by payers and hospitals and features a payer data assessment by region and service code. The report reveals in part that payer and provider compliance numbers are growing. For example, 183 payers published data as of March 2023 compared to just 68 payers last July 2022. The payer data now represents more than 95% of commercially insured people in America. Meanwhile, 84% of hospitals have posted pricing data as of Q1 in 2023, compared to just 65% in Q4 of 2022.
Co-Founder & CEO
Turquoise Health
The news comes after Turquoise Health Co-Founder and CEO Chris Severn was called before the House Committee of Energy and Commerce Subcommittee on Health to testify on the current state of price transparency, its impact and what’s to come.
“Price transparency has passed a major inflection point, and it’s important for the public, government, and industry to recognize progress in order to invest in the opportunities at hand,” said Severn. “[Our] report both highlights advancements in the usability of price transparency data and underscores the need for the government to evolve technical requirements and enforce compliance.”
Movement is gaining momentum, but it’s a slow process. “The idea that you have price transparency legislation come out and then everything is fixed a month or two later is not realistic,” added Dorstel. “It takes years, really, especially in an industry like healthcare. So, we’re a couple of years into this multi-year journey but we’re already seeing the impact and we are very excited about what’s to come with the eventual goal of eliminating the financial complexity of healthcare.”
With its headquarters located downtown, Turquoise Health has grown since its 2020 launch from three employees to 90 employees. “We recently won a Modern Healthcare’s Best Places to Work 2023 award. It shows that we were also building our company in a mindful way such that employees would want to work with us and do so for a long time so that award was a great recognition that our culture and organization are working,” he added. The company now has 150 customers nationwide.
“Healthcare is complicated and complex and hard to change but there’s a lot that we’re doing to chip away at that and get to that long-term mission and goal,” he added.
Turquoise Health
FOUNDED: 2020
CEO: Chris Severn
HEADQUARTERS: San Diego
EMPLOYEES: 90
BUSINESS: Software development
WEBSITE: turquoise.health
CONTACT: info@turquoise.health
NOTABLE: Turquoise Health was voted one of Modern Healthcare’s Best Places to Work 2023.
