What's next for payer price transparency: 5 things to know

Payers have been required to post all of their negotiated rates in publicly available files since July 2022, and most have done so, according to Turquoise Health. 

The company, which develops price transparency software, published its first quarter "Payer Transparency Impact Report" on April 18. 

Here are five things to know about payers' price transparency from the report: 

  1. Chris Severn, CEO of Turquoise Health, told Becker's the biggest misconception about price transparency data is that it is unusable.

    Though payer price transparency data files are large, they are usable, according to Turquoise Health's report. The company gave 159 payers top scores for accessible file sizes in the impact report.

  1. Payer data came online quicker than hospital transparency data, according to Turquoise Health. The organization has reviewed data for at least 183 payers, up from 68 in July 2022, when price transparency requirements for insurers first took effect.

    "In contrast to the hospitals, payers really acted pretty quickly," Mr. Severn said. "We're about 10 months in, and in the first quarter of compliance, you saw most of the big payers publish files. I'd say there was a speed to action that was a stark contrast to that of hospitals."

  2. It is more difficult to assess the completeness of payers' price transparency files than hospitals. It's also difficult to know the true size of payers' networks and every service that should be included, according to Turquoise Health's report.

    Some payer files may be missing provider rates, or certain states, but are still valuable overall, Mr. Severn said.

    "Maybe there are gaps that are artifacts or bugs of the generation process, but let's not be so quick to dismiss an entire payer's publication, just because we brought up one rate that doesn't look right to us," he said. 

  1. Turquoise Health's site that helps consumers compare rates had five times as many visits in 2022 than 2021, another indicator more consumers are using data is the proliferation of startup companies creating price transparency tools, Mr. Severn said. 

  1. Major health systems and payers are using price transparency data for negotiations, and it's shaking up the process.

    "It feels a little bit like folks are playing chess in the dark. We've just turned the lights on. That's all that happened," Mr. Severn said. "I think a lot of the moves, historically, have been a bit aimless. When the lights are turned on, you notice 'Wait, what are we doing here? This doesn't make any sense.'

    "All the major health systems and payers are using this data for negotiations. The conversations are more data driven now, and also a bit awkward," he added. "Because, this is the first reckoning of hyper-granular negotiated rates data, so it's going to have a huge impact. It already is." 

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