Round Two Diligence: Benefit Intelligence Infrastructure Shortlist

Reviewed February 18, 2026

I. Objective

Answer the hard questions before procurement, not after integration.

This round focuses on six vendors and six diligence questions tied to your actual product: a 360 member benefit experience that can recommend plan changes, explain savings logic, and safely operationalize enrollment changes. Findings are based on public primary-source documentation and are explicitly marked where inference is required.

The Six Questions This Report Answers

Q1
Can this vendor provide recommendation-grade member and plan data (not just connectivity claims)?
Q2
Can recommendations be explained, audited, and defended with source-level evidence?
Q3
What is the real integration effort in production, including onboarding and environment constraints?
Q4
How transparent are economics and marginal scaling costs from public information?
Q5
How portable is your architecture if you need to exit or dual-source a vendor later?
Q6
How well does this vendor directly support your first two recommendation use cases (vision upgrade and dental downgrade)?

No single company in this set cleanly covers claims, plan design, enrollment execution, and analytics portability by itself.

II. Answers Matrix

Question-by-question answers across the six-company shortlist.

Vendor Q1 Data Fit Q2 Explainability Q3 Integration Reality Q4 Economics Q5 Portability Q6 Use-case Fit Pilot Readiness Best Role In Your Stack

III. Vendor Findings

Each company, answered against the same six-question lens.

IV. Stack Design

Practical architecture for your 360 benefit intelligence service.

Inference from sources: the best near-term path is a composable stack rather than single-vendor dependence. Use plan intelligence and recommendation rails separately from enrollment execution and enterprise analytics.

Layer A

Member Data Ingestion And Consent

Flexpa as the primary consent-driven data rail for payer claims plus provider-side records where needed. Add Optum only if you need enterprise transaction depth for eligibility/claims workflows that exceed payer-access APIs.

Layer B

Plan Intelligence And Recommendation Engine

Ideon for plan/rate/provider/network normalization (including dental and vision dimensions) to power recommendation simulations and savings estimates before or during open enrollment.

Layer C

Execution, Activation, And Enterprise Analytics

Noyo for enrollment and eligibility execution when recommendation outputs need operational action. Arcadia for broader analytics and longitudinal modeling. Oracle Health is optional for deeper EHR-side workflows in Oracle-heavy provider contexts.

Implementation Implication

Your proprietary moat should be recommendation logic, experiment framework, and member communication UX. Vendor APIs should be treated as swappable data and transaction adapters behind a normalized internal contract.

V. Go / No-Go Gates

What to demand in round-two vendor sessions.

Hard Gates Before Pilot

  1. Deliver sample payloads that can compute both pilot use cases end-to-end with real fields, not synthetic examples.
  2. Provide data freshness and completeness SLAs by line of business.
  3. Demonstrate recommendation traceability to source records and timestamps.
  4. Show failure handling for missing, masked, or delayed fields.
  5. Confirm production onboarding path and minimum timeline with named dependencies.
  6. Contractually define uptime and incident communication obligations.

Commercial And Exit Gates

  1. Provide full fee schedule: implementation, recurring, usage, support, and overage terms.
  2. Clarify per-member and per-connection marginal costs for national scaling.
  3. Define data export rights and formats at termination.
  4. Commit to backward-compatible versioning windows for critical APIs.
  5. Disclose subcontractor dependencies for data retrieval and hosting.
  6. Confirm BAA terms, security attestations, and breach notification windows.

VI. Sources

Primary evidence links used for this report.