Understanding negotiated rates between insurers and providers is easier said than done due to the sheer volume of data.
Price transparency regulations have the potential to aid the shift to value-based care, but parsing the data currently available remains a challenge.
Uncovering total cost of care not only benefits patients, but it allows providers and payers to negotiate with one another based on the volume and quality of care delivered.
However, price transparency compliance continues to lag on the hospital side, with a recent report by PatientRightsAdvocate.org finding that 75.5% of hospitals are still not adhering to the rule.
On the payer side, there's been no shortage of data since the law went into effect on July 1, 2022, with Turquoise Health recently reporting that it amassed 630 terabytes of insurer price transparency data. Despite the overwhelming volume, payers have yet to figure out the best way to display all that information, as payer-machine readable files have varied 50-100 times in size, according to Turquoise Health.
In a previous interview with HealthLeaders, Turquoise Health CEO Chris Severn spoke to the price transparency rules' long-term impact on the healthcare system, when done right.
Severn said: "As the adoption of the current rules and laws continues to increase, we believe that data will inspire positive changes, such as transparent contracting and less variability in pricing. Both of those would in turn help move the needle closer to fair prices of services, but those positive effects take time."
To make sense of the data that is available right now, companies like Turquoise Health are developing platforms that allow for the comparison of providers, payers, and costs of services.
Trilliant Health has released its own health plan price transparency analytics tool that can shed light on negotiated rates for services rendered, the company announced.
Ultimately, Trilliant CEO Hal Andrews said, "health plan price transparency data will enable value-based competition, revealing the best value for any service in any market under fee-for-service arrangements."
Jay Asser is the contributing editor for strategy at HealthLeaders.
KEY TAKEAWAYS
Both the hospital and payer price transparency rules have had their struggles so far in terms of compliance and presentation of data.
When the regulations work as intended, they have the potential to significantly help the efforts towards value-based care.
In the meantime, companies are developing tools to make the data more accessible and digestible.