Exponent Health
Software & Data
Gaithersburg, Maryland

Overall Rank: 88
Category: Software & Data
Category Rank: 34

Awards:

  • Top HealthTech Company of 2022

Profile

For 30+ years, Exponent Health™ has been solving complex cost management and revenue optimization challenges across healthcare—from large, national payors and Blues plans, to PBMs and TPAs. Exponent Health enhances clients’ competitive edge and accelerates their business through amplified cost savings, transparency, and advanced analytics. Designed around client-specific needs, its specialized solutions focus on niche medical claim needs including out-of-network claims, regulatory compliance, and high-dollar bill audits and pharmacy decision support, including formulary rebate management, specialty drugs, and underwriting and sales support.


As a technology company dedicated to healthcare cost reduction, Exponent Health is leading the future with solutions powered by Expio™. Expio brings together artificial intelligence, automation, data, and analytics across medical and pharmacy into a next generation platform to create powerful solutions for unlocking savings opportunities. From formulary optimization to dynamic medical claim repricing to cloud-based analytics, Expio intelligently delivers optimizations and insights to amplify business success—and it is all supported by best-in-class operations and the highest security and compliance standards, including HITRUST certification.


As an independent cost management solutions provider, Exponent Health is fully dedicated to its clients’ success. It has grown to serve more than 70 national and regional payors and manages more than $2.5 billion in healthcare spend.


Visit exponenthealth.com


Key Products

Pharmacy Solutions


Formulary Rebate Optimization


Power up with Expio™. Exponent Health powerful formulary optimization tools, together with their deep understanding of your unique business needs, gives you the most effective, lowest net-cost strategies, including industry-leading contracting guarantees. This powerfully dynamic pharmacy rebate solution allows you to integrate medical rebates or support them as a standalone option to exponentially optimize every outcome.


Specialty Pharmacy Management


Lowering specialty pharmacy costs is just one of the ways we provide value. At Exponent Health they leverage Expio’s AI-driven pricing logic, enabling specialty drug discount guarantees that include all sources of savings, creating true net-cost drug guarantees. By combining their innovative pricing model with clinical benefit oversight and robust analytics, they ensure that you have a holistic, forward-thinking specialty pharmacy rebate strategy in place.


Medical Rebate Strategy


Exponent Health have over 30 years of experience in managing cost optimization services for pharmacy and medical benefits. Giving them the power to combine a deep understanding of prescriber behavior with a portfolio of medical rebate contracts, biosimilar strategy support, and prescriber engagement solutions, to secure maximum rebate value for your business.


Power Insights


Time is money. Expio’s 24/7, cloud-based analytics suite helps you make the most of it. By providing clarity and insights to actively manage your business and real-time performance data, trends, and forecasting tools and by drilling down to claim-level details. Giving you the power to zero-in on what matters.


 


Medical Solutions


Out-of-Network Fee Negotiation


Exponent Health experienced negotiators utilize their innovative ExpioTM pricing tools to reveal essential insights that allow you to secure market-leading discounts, prevent balance billing, and virtually eliminate appeals.


AI-Driven Repricing Optimization


Raise your savings game with AI. Their ExpioTM engine integrates and analyzes proprietary and industry benchmark data to find the unmatched repricing solutions for each claim, to maximize savings and minimize disputes.


Cross-Vendor Dynamic Price Optimization


Take price optimization to the next level. For unrivaled, comprehensive price solutions, choose Exponent Health to be your central clearinghouse to find the best discount across all repricing partners in your stack.


Compliant Pricing Solutions


Exponent Health always evolving suite of solutions help you adapt to the changing regulatory environment. From a proprietary Medicaid pricing algorithm, to federal (No Surprises Act) and state balance billing laws, they make sure you’re always in compliance.


Advanced Intelligence, 24/7


Get a clear and unmatched view anytime, anywhere, so you’re always ready to take action. Expio’s advanced analytics suite provides deep insights and a transparent understanding of your performance data in real-time to help you strategize like never before.


 


Provider Solutions


Claims Reconciliation. At Your Speed.


The Expio™ optimization engine gives you data mining automation technology for fast claims data verification from payor websites to identify denied, pending, or unprocessed claims. Exponent Health makes it fast and easy to integrate with the daily workflow of any healthcare claims software, saving you valuable administrative time, reducing A/R, and accelerating your cash flow.


Advanced Analytics. Actionable Insights.


Expio’s cloud-based analytics provide comprehensive claim insights in real-time. Get fast access to denial data, days in AR drivers, claim resolution rates, and essential performance benchmarks for actionable intelligence needed to optimize your operational and financial performance.