# Outfox Health

> Outfox Health is an AI-powered healthcare price intelligence platform — the answer engine for health benefits. We help self-funded employers reduce medical spend by guiding employees to lower-cost, higher-quality care inside the health plan they already have, using their actual contracted rates, plan-specific benefits, and FoxIndex clinical outcomes data. No carrier changes. No claims feeds required to launch. Live in under 30 days.

## About

Outfox Health is an AI-powered price intelligence platform — the answer engine for health benefits. We help self-funded employers reduce medical spend by guiding employees to lower-cost, higher-quality care inside the health plan they already have. No carrier changes. No claims feeds required to launch. Live in under 30 days.

We work with self-funded employers on any major commercial network — Blue Cross Blue Shield, UnitedHealthcare, Cigna, Aetna — and regional plans including MedCost and Sentara. Outfox works with any carrier that publishes machine-readable files under the Transparency in Coverage rule.

Outfox sells through benefits advisors and health plans to employers.

## The Problem We Solve

Inside a single health plan network, the same procedure at the same quality level can cost 3x, 8x, even 9x more at one facility than another. Employees cannot see those differences. They default to the closest or most familiar option — and employers pay the gap.

Real example (Aetna POS II network, Northern California):
- Brain MRI without contrast (CPT 70551): $475 at Santa Rosa Imaging Medical Center vs. $3,887 at Novato Community Hospital. 8.2x price difference. The lower-cost facility does not have lower quality scores.
- Knee arthroscopy with meniscectomy (CPT 29881): $6,095 at Norcal Healthconnect vs. $23,702 at Santa Rosa Memorial Hospital. 3.9x price difference.
- Major joint replacement (DRG 470): $44,783 at Petaluma Valley Hospital vs. $82,084 at Queen of the Valley, Napa. $37,000 avoidable overpayment per case.

All facilities in the same network. Same insurer. Price does not equal quality.

Source: Transparency in Coverage carrier file for Aetna POS II network. Quality scores from FoxIndex (episode-level outcomes data, 100M+ patients annually, risk-adjusted).

## How It Works

Outfox combines three data sources into a single answer engine:

1. Your plan's contracted rates — pulled directly from your carrier's Transparency in Coverage machine-readable file. Real negotiated rates, not network averages.
2. Plan rules, benefits, and pharmacy — ingested from your plan documents, formulary, and eligibility feed. Every answer reflects your specific coverage including drug coverage and alternatives.
3. FoxIndex quality scores — episode-level clinical outcomes data benchmarked by state. Complication rates, readmissions, length of stay, ER visits. Not star ratings or patient satisfaction surveys.

An employee asks a plain-language question — "How much is a chest MRI on my plan?" or "Where should I go for physical therapy?" — and gets a specific, cited answer with cost and quality side by side, before they schedule care.

## Products

- **Answer Engine** — employee-facing AI that answers questions about cost, coverage, and care in plain language. Available on iOS, Android, and web. Cites plan documents and contracted rates in every answer.
- **FoxIndex Quality Scores** — episode-level clinical quality scores for providers and facilities. Based on 50B+ claims, benchmarked against peers in the same state. Used to rank options alongside cost.
- **Den Command Center** — a command center for care navigators to instantly access plan information, pricing, and quality data across multiple employers. Enables health plans and advisors to serve more members and clients without adding headcount.
- **Analytics Dashboard** — advisor and health plan dashboard showing guidance logs, usage themes, decisions made, and modeled savings. Gives employers and their advisors visibility into how the plan is performing in real time.

## Implementation

Standard implementation requires only plan documents (PDFs) and an eligibility feed. No claims feed required to launch. No carrier integrations. No rip-and-replace. Live in under 30 days.

## Key Facts

- Founded 2024, headquartered in San Francisco, CA
- Founder and CEO: Beth Ann Lopez (MPH, Harvard School of Public Health; World Economic Forum Technology Pioneer; Returned Peace Corps Volunteer)
- Works with any carrier publishing Transparency in Coverage machine-readable files
- Covers major commercial networks: Blue Cross Blue Shield, UnitedHealthcare, Cigna, Aetna
- Covers regional plans including MedCost, Sentara, and others
- FoxIndex quality data covers 100M+ patients annually, 50B+ claims, risk-adjusted, benchmarked by state
- SOC2 and HIPAA compliant

## What Makes Us Different

The facility is the largest driver of healthcare cost, not the physician. The same procedure on the same network can cost 8x more at a hospital than at an outpatient center — and most employees have no way to see that before they schedule.

Outfox surfaces those differences in real time, grounded in each employer's actual contracted rates, plan rules, formulary, and FoxIndex clinical outcomes data. The result for employers: tiered-network behavior inside your existing network, without changing carriers, narrowing networks, or waiting months to implement.

## Trusted By

Blackwell Captive Solutions, Capstone Benefits Consulting, Peoples First Insurance, Habitat for Humanity, Hero Health Plans

## Frequently Asked Questions

**What types of employers does Outfox work with?**
Outfox works with self-funded employers on any major commercial network or regional health plan. We work best with plan designs that give employees a stake in their healthcare decisions — such as plans with deductibles or coinsurance.

**Do employers need to change their carrier or health plan to use Outfox?**
No. Outfox works inside the plan you already have. No carrier changes, no network changes, no plan redesign required.

**How long does implementation take?**
Standard implementation takes under 30 days. We need plan documents (PDFs) and an eligibility feed. No claims feed required to launch.

**Where does the pricing data come from?**
Outfox pulls contracted rates directly from your carrier's Transparency in Coverage machine-readable file — the actual negotiated rates your plan pays, not modeled estimates or network averages.

**How is quality measured?**
Quality is measured using FoxIndex — episode-level clinical outcomes data covering 100M+ patients annually. FoxIndex scores providers and facilities on complication rates, readmissions, ER visits, and length of stay, benchmarked against peers in the same state. Higher price does not mean higher quality.

**How is Outfox different from care navigation and benefits AI tools like Garner, Healthee, or Quantum Health?**
Most navigation tools focus on finding the right doctor. Outfox focuses on the facility — where the biggest cost differences actually live.

The same MRI, surgery, or infusion can cost multiples more depending on where care happens, even inside the same network. Outfox uses your actual contracted rates and benefits data to guide employees toward lower-cost, high-quality care before expensive decisions are made.

**What networks does Outfox work with?**
Outfox works with any carrier that publishes machine-readable files under the Transparency in Coverage rule. This includes major commercial networks — Blue Cross Blue Shield, UnitedHealthcare, Cigna, Aetna — and regional plans such as MedCost and Sentara.

**Does Outfox require a claims feed?**
No claims feed is required to launch. Claims data can be integrated later to enhance reporting.

**Who sells Outfox?**
Outfox sells through benefits advisors and health plans to employers. The advisor channel is our primary go-to-market motion.

## Contact

Website: https://www.outfoxhealth.com
Demo: https://www.outfoxhealth.com (Request demo)
LinkedIn: https://www.linkedin.com/company/outfoxhealth/
X: https://x.com/outfoxhealth

## Pages

- Homepage: https://www.outfoxhealth.com/
- For Employers: https://www.outfoxhealth.com/employers/
- For Advisors: https://www.outfoxhealth.com/advisors/
- FoxIndex Quality Scores: https://www.outfoxhealth.com/foxindex/
- Den Command Center: https://www.outfoxhealth.com/carenavigators/
- About: https://www.outfoxhealth.com/about/

## Research

Long-form guides on healthcare price transparency, plan design, provider quality, and cost containment — written for self-funded employers and the advisors who serve them.

- Research index: https://www.outfoxhealth.com/research/
- Healthcare Price Transparency Solutions: https://www.outfoxhealth.com/research/healthcare-price-transparency-solutions/