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.
§4.2Tier Assignment§5.1Step Therapy§3.4DAW Override§6.3Quantity Limit§7.1Prior Auth§2.8Age RestrictionTest changes before deploying
Run what-if scenarios to see how specific changes would have affected outcomes — including side effects.
§4.2 Tier Assignment:Tier 3Tier 2Optimize 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.
Know your leverage before you negotiate
See which clauses drove cost and which never triggered—documented with verified data.
Test plan changes before they go live
Simulate your new design against 12 months of actual claims.
Fix root causes, not just findings
Trace findings to the exact rules that caused them—and validate fixes.
See what you're leaving on the table
Surface opportunities ranked by verified impact—not vendor projections.
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.