This article is sponsored by Trella Health. Trella Health’s new commercial payer rates data solution unlocks critical insights for HME organizations. In a conversation with HME Business, Mimi Freleaux, Product Manager of Insights Platform at Trella Health, explores how this data empowers businesses to navigate pricing strategies, enhance negotiation leverage, strengthen partnerships and make smarter, data-driven decisions for growth.
HME Business: What life and career experiences do you most draw from, in your role today?
Mimi Freleaux: I’ve spent 14 years in health care, taking on diverse roles across various sectors, including physician groups, health systems, post-acute care, HME, and infusion. My career began in enterprise sales, focusing on health systems and physician groups. Over time, I transitioned into roles such as a solutions engineer, which deepened my understanding of the challenges health care organizations face and the solutions they need to succeed.
In every role, my focus has been on solving customer problems. How can we identify and address the challenges they face? In my current role, I spend a lot of time evaluating data—what we can access and how we can make it valuable for our customers. For example, we’ve recently acquired payer rates data, which we see as a key resource in helping our clients make more informed decisions.
Trella Health is now offering commercial negotiated payer rates data, as you mentioned. How is Trella able to provide access to this type of data?
Thanks to the Health Plan Price Transparency Act, we now have access to valuable data that, while technically publicly available, is incredibly challenging to navigate. This legislation rolled out in phases, starting July 1, 2022, when payers were required to share a subset of codes. The real game-changer came on January 1, 2023, when the law mandated that every commercial plan release all their negotiated rates for every provider and code.
The law requires payers to make this information available on their websites in machine-readable files. However, if you’ve ever reviewed those files, you know how complex they can be. Each file is closely interconnected, with content from one often linking to another, and their layouts can differ significantly. Some of these files are massive, and downloading just one of these files on a home laptop could take around 15 hours—and there are thousands of such files to handle. This is where we step in—turning that complex, raw data into actionable cleaned-up data for our clients.
If this data is publicly available, why can’t HME organizations get it themselves?
The machine-readable files required by the Health Plan Price Transparency Act contain massive data sets that are nearly impossible for most organizations to manage without technical expertise. To pull all this data in, you’d need someone highly skilled to not only extract it every single month but also identify all the relevant plans and web scrape the required information. It is a very time-consuming process.
These files are enormous—about 3-4 TB of data each month—and making sense of it is daunting. That’s where Trella Health comes in. We consolidate this raw data, organize it into a data repository and provide our customers with actionable insights. Instead of dealing with an overwhelming flood of information, they can request specific rates for certain codes and dates. We parse the data down to exactly what they need and deliver a clear and concise report.
This allows customers to determine whether they’re being paid fairly. For example, they can compare their reimbursement rates to competitors for the same services. It’s like pulling back the curtain and finally gaining transparency into what everyone else in the market is getting paid.
With access to this pay rates data, what specific insights can organizations leverage from it?
The insights from this data offer a lot of benefits. First, it provides contract negotiation leverage. By understanding market rates, organizations can approach payer negotiations armed with evidence. For example, they can say, “We know you’re paying others $75 per unit, yet we’re only receiving $56. Let’s discuss why we deserve higher rates, especially considering the superior care we provide.” This transparency turns guesswork into actionable strategy and allows organizations to achieve more competitive reimbursement terms.
Second, the data lends itself to developing strategic payer relationships. Analyzing payer trends helps organizations identify which payers have the most favorable rates or terms, which is especially useful for market expansion.
Third, this data can uncover opportunities to expand offerings. If certain products or services adjacent to the current lineup are highly reimbursed, organizations can consider adding them to their portfolio. This way, businesses can gauge market share potential before even entering and build a solid roadmap for growth.
What are the main use cases HME organizations are using to grow their business and improve outcomes?
A key strategy is negotiating competitive rates—identifying payers with pricing gaps and benchmarking rates against competitors in similar categories. Another approach involves identifying new contract opportunities by uncovering payers in your state or market that offer favorable rates for your services. Additionally, broadening product offerings plays a significant role—finding complementary products that align with existing contracts. Expanding into new markets is equally important; assessing rates and competition in new regions can drive strategic growth. Finally, HME organizations are leveraging this data to evaluate acquisition opportunities, whether by acquiring groups with excellent rates for immediate leverage or weaker rates where they can apply their stronger contracts.
With access to these insights, what is one quick win HME organizations can achieve with this data?
Negotiating competitive rates is a top priority because organizations can secure quick wins without investing in additional resources. For example, increasing a rate by 10% directly translates to a 10% gain without any extra work. It’s a straightforward win that maximizes value simply through better negotiation.
Finish this sentence: “In the HME space, 2025 will be defined by…”
… data and market insights as a competitive advantage. In 2025, HME organizations will rely on deep market insights to identify top referral sources, uncover emerging demand and optimize territory planning. Companies will also leverage predictive insights like tracking referral patterns and patient demographics to anticipate market needs and adjust as necessary.
Editor’s note: This article has been edited for length and clarity.
Trella Health empowers HME organization with integrated market intelligence and CRM tools needed to make informed decisions and drive growth. Discover how our platform helps you pinpoint high-value referral sources, expand strategically in your market, and maximize ROI. Ready to see the Trella Health advantage? Request a demo today at https://www.trellahealth.com/demo
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].