Payerset

Employers empowered with price transparency is one piece of the puzzle. Great recap of the National Alliance of Healthcare Purchaser Coalitions Summit from Andrew S. Gordon, LSW.

Payers are walking into contract negotiations with price transparency data. Some hospitals are walking in without it. At Becker's Healthcare Annual Meeting this week, Jacob L. sat down with Richard Cho and Jim Haulihan, MBA, MPT, FACHE from PurpleLab in front of an audience of CEOs, CFOs, managed care leaders, and compliance officers from hospitals to work through what that asymmetry looks like in practice. This data is being used by everyone from health plans and large health systems to smaller provider groups. One of our goals is to make sure it works just as well for rural hospitals with thin margins and independent practices that have never had a basis for pushing back on a rate offer. Check out the key takeaways below 👇

Our CEO, Jerry DiMaso, recently joined Stacey Richter on the Relentless Health Value Podcast to talk about the state of price transparency, empowering employers, and what a functioning healthcare market actually means. A few of our favorite highlights: 𝗙𝗼𝗿 𝗽𝗹𝗮𝗻 𝘀𝗽𝗼𝗻𝘀𝗼𝗿𝘀: You can now search your own plan by EIN and compare your negotiated rates directly against other employers in your industry. The disparities can be significant. A TPA's 90% aggregate discount number looks very different when you break it down to the codes that actually drive your spend. 𝗙𝗼𝗿 𝗶𝗻𝗱𝗲𝗽𝗲𝗻𝗱𝗲𝗻𝘁 𝗽𝗿𝗼𝘃𝗶𝗱𝗲𝗿𝘀: The shift is about closing an information gap that has historically been one-sided. Carriers negotiate with thousands of practices and have a full picture of market rates. Most independent practices have only ever seen their own contracts. That is changing. Providers who pair rate benchmarking data with their own quality and outcomes data are having more grounded, specific conversations with payers than they could before. 𝗧𝗵𝗲 𝗯𝗶𝗴𝗴𝗲𝗿 𝗽𝗶𝗰𝘁𝘂𝗿𝗲: When independent practices run out of runway on rates and sell to larger health systems, all the prices go up. Keeping smaller practices viable is good for everyone in the ecosystem, and transparency data gives them a better argument before they reach that point. Lastly, employers have a fiduciary responsibility to their employees. Now that transparency is becoming more accessible, "we didn't know" is quickly becoming unacceptable. Take a listen here directly here: https://lnkd.in/e8tEcX-T We also expanded on some of these discussion points: Link in the comments below 👇 #PriceTransparency #HealthcareData #PayerContracting #IndependentProviders #PlanSponsors #HealthValue

April 1 was the enforcement deadline for CMS's version 3.0.0 hospital price transparency update, and it's the most significant methodological change to the hospital machine-readable file since the rule took effect in 2021. Hospitals can no longer publish a single "estimated allowed amount" for percentage-based contracts. They're now required to publish the median, 10th percentile, and 90th percentile of actual allowed amounts. A tight band signals a relatively stable, predictable contract while a wide band tells you something more complex is going on underneath. Two other highlights: 1. Formal attestation requirement naming a senior hospital official responsible for data accuracy 2. Standardized organizational NPI field that creates a cleaner bridge between hospital MRFs and other provider datasets. We wrote up the full breakdown, including what the percentile structure actually tells you and how to use the new observation count field in practice. https://lnkd.in/eQSHEGrC #PriceTransparency #HealthcarePolicy #MachineReadableFiles #TransparencyInCoverage #HealthcareCompliance #ManagedCare #RevenueIntegrity

Healthcare Financial Management Association (HFMA) events never disappoint! Hear from our very own Andrew S. Gordon, LSW about the Joseph A. Levi 66th Annual Institute last week in NYC.

Still thinking about this previous episode from our friends at Relentless Health Value Podcast! Love being able to support Stacey Richter & team as they not only shine a light on so many broken aspects of healthcare, but highlight folks who are working everyday to make change.

True story: we recently reviewed an external analysis comparing emergency visit reimbursement between two competing health systems. The conclusion? Hospital A receives 1.5x more than Hospital B.... which, in fact, turned out to be wrong. Not only wrong, but when we looked at the complete picture, Hospital B was actually being reimbursed higher. Part 2 of our benchmarking deep-dive is here! We take a look at a practical example of what comprehensive benchmarking takes. https://lnkd.in/eawhTtws

We're finishing up parsing & validating our full Q1 data refresh, which will be the first full refresh with Schema 2.0. In the coming weeks, we'll update our TiC Schema 2.0 update tracker with learnings from this big shift, who's compliant and who could use improvement, and more. https://lnkd.in/e-ZwjRgY In the meantime, check out Jerry DiMaso reviewing a few of the new fields available to increase usability.

Every reimbursement benchmarking analysis is different. In Part 1 of our two-part series, we pull together lessons learned from hundreds of customer conversations to help you navigate that complexity. Check it out here: https://lnkd.in/egK64s3z Here are a few of our favorite takeways: ▸ No single data source tells the full story. Payer MRFs, hospital MRFs, and claims data each play a distinct role, and the best work triangulates all three. ▸ Build clinically appropriate bundles. Single-code comparisons rarely tell you what you think they do. ▸ Understand the contract structure behind the rate. Fee schedules, percent-of-charge, case rates, and carve-outs all require different analytical approaches. We also get into why validation with claims data matters, how service type changes the methodology, and some honest caveats about what this data can and can't tell you. Part 2 will take everything from the framework and puts it into practice, breaking down an emergency visit comparison across two peer hospital systems. Stay tuned.

Accurate benchmarking means using all tools available. Price Transparency + Claims helps tell the complete story vs. relying on partial views. The first of a 2-part blog series drops tomorrow consolidating lessons we've learned from customers into a framework for using price transparency and claims for detailed reimbursement benchmarking.