What we've learned so far from payer price transparency data

Payers have been required to publish the cost of nearly every service negotiated with providers since July 1. Here's what we know so far about this data and the insights researchers have gleaned from payers' negotiated prices. 

1. There's a lot of data out there.

According to an Oct. 2022 report from Turquoise Health, an estimated 500 terabytes of payer-negotiated price data is available online. This includes all of the nation's largest payers, and many regional carriers, with over 80 organizations included in the data. The negotiated rates for many Fortune 500 companies' plans are available as well. 

2. While the data is available, it's not yet usable for the average consumer. 

With such a massive amount of data available, much of it in machine-readable files designed to be analyzed by researchers, it's difficult for customers to make sense of. 

"This raw data at the consumer level is really not very helpful," Blue Cross Blue Shield Minnesota President and CEO Dana Erickson told Becker's in July. "We have to go to where we can take the data and make it actionable for consumers to make better healthcare decisions."

The Transparency in Coverage rule requires payers to create an online cost estimator tool by January 1, 2023, for the 500 most common services, and have all services available in this tool by 2024. According to AHIP, around 94 percent of commercial insurers already have these tools available. 

3. Third-party companies are also developing price transparency tools, which could be available in the coming months.  

Developers are working to make the data usable for consumers, researchers and other stakeholders. 

Turquoise Health and Komodo Health are partnering to create a platform to help consumers understand the full cost of healthcare services and streamline payer-provider contracts.

In its October report, Turquoise Health said it expects the first tools using this data to become available in early 2023. 

"Innovators, patients, and lawmakers have waited decades for this data. We will have to wait a few months more for the data to make its way into useful patient experiences at scale," Turquoise Health said in the report. 

States are also interested in developing their own price comparison tools for residents. In August, New Mexico said it is planning to launch its own price transparency database. The state is working with data and analytics company Milliman MedInsight to create the database. The company has done similar work in Utah, Virginia and New Hampshire. 

4. Hospitals are also required to post their prices, but not all of them have. 

Hospitals have been required to make their prices for services publicly available since January 2021. 

According to Turquoise Health's report, 65 percent of hospitals have published machine-readable files of their negotiated rates with payers, and 63 percent have published files including cash prices for services. 

Enforcement of these laws has been lax so far, advocates say. CMS fined two Georgia hospitals in June for not complying with transparency requirements. 

5. Payer and provider data doesn't always match up. 

Advocacy group Patient Rights Advocate compared price transparency data from some of the nation's largest hospital systems and payer data. 

The group's report, published in October, found several instances where prices that appeared in payer disclosures were omitted from the hospitals' disclosures. Patient Rights Advocate says this indicates some hospitals are "flouting" price transparency laws. 

6. Some researchers are already making use of payer negotiated price data. 

While usable payer prices for consumers may be months away, research studies have already been published digging into the data. 

A study published Oct. 18 in Radiology found payer-negotiated prices for radiology services can vary widely, even within the same hospital. On average, the highest negotiated price for radiology services was 3.8 times higher than the lowest negotiated price.

Another study, published Sept. 15 in the American Journal of Managed Care, found payers generally negotiated lower prices for ACA exchange plans than commercial group rates at the same hospital.

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