5 Ways Provider Organizations Can Utilize Health Plan Price Transparency Data

Author: Maria Nikol, MJ

The Transparency in Coverage rule, introduced by the Centers for Medicare & Medicaid Services (CMS), aims to increase price transparency in the healthcare industry. As part of this rule, health insurers are required to provide clear, accessible information on pricing and cost-sharing for healthcare services via Machine-Readable Files. Insurers must publish detailed pricing data in machine-readable files, making it easier for third-party developers to create tools and apps that consumers can use to compare prices across different healthcare providers. The rule has phased implementation dates, starting from January 1, 2023.

While the original intent of the rule was to ensure consumers are empowered with the critical information they need to make informed health care decisions, provider organizations can also utilize this data across the entire value-based risk continuum (starting from fee-for-service, all the way to full risk).  These strategic initiatives aim to improve their operations, patient satisfaction, and financial performance.

1.     Setting Competitive Pricing: By analyzing transparency data, provider organizations can benchmark their prices against competitors in the same geographic area or specialty. This helps them set competitive pricing strategies that attract patients while maintaining profitability.

2.     Negotiating with Payers: Armed with pricing transparency data, providers can negotiate more effectively with insurance companies and other payers. They can justify their pricing structures based on market data and negotiate fair reimbursement rates that reflect the value of their services.

3.     Driving Operational Efficiency: Analyzing pricing data can uncover inefficiencies in cost structures and resource allocation. Providers can identify areas for cost savings and operational improvements, enhancing efficiency without compromising patient care quality.

4.     Preparing for Value-Based Care: As healthcare moves towards value-based reimbursement models, transparency data helps providers demonstrate the value of their services in terms of outcomes and patient satisfaction. This positions them favorably in value-based care negotiations and partnerships.

5.     Supporting Strategic Planning and Growth: Transparency data provides strategic insights that support long-term planning and growth initiatives. Providers can identify expansion opportunities, evaluate market trends, and forecast financial performance more accurately. This information can also be utilized when evaluating whether to sell a practice to venture capital or stay independent.

Healthcare price transparency data empowers provider organizations to optimize pricing strategies, improve financial performance, and navigate regulatory challenges effectively in an increasingly competitive healthcare landscape.

At Revelar, we understand that human-readable data is the cornerstone of informed decision-making in healthcare. Our team of dedicated data analysts leverages cutting-edge technology to provide our clients with unparalleled price transparency. Contact us today to learn more about our solution and services.