The Price is Right (or is it?): Decoding Transparency Data
A long running limitation for healthcare industry research has been a lack of transparency in contract pricing, particularly with hospitals, leaving patients to discover the cost of care only after they are discharged. This lack of available data on average market prices has similarly left both provider and payer stakeholders uninformed in their commercial rate negotiations. Now, following major changes to CMS rules in 2021 and 2022, hospitals and health insurers are required to disclose the negotiated contracted prices for in-network services and for self-pay patients. Due to this change, industry analysts now have an unprecedented view into hospital pricing, one of the largest drivers of healthcare costs in the US. To assess hospitals' and payers' response, the Clarify Health Institute is completing an analysis of negotiated prices across hospital markets documenting the substantial variation in negotiated rates both within and across local healthcare markets throughout the United States. We found that variation is not distributed evenly; there are certain types of services which experience more dramatic variation in pricing and market competitiveness plays an important role. In addition, we highlight how hospitals and payers are increasingly impacted by and leveraging publicly available rate data in their commercial price negotiations.
- Illustrate how new federal regulations requiring provider and payer reporting of negotiated rates for healthcare services may be compiled and analyzed
- Using compiled hospital and payer negotiated rates data compared to Medicare payment benchmarks, document substantial variation in negotiated rates across states and local healthcare markets through the United States
- Highlight the types of healthcare services provided by hospitals with the largest range of variation in negotiated prices nationally relative to Medicare payment benchmarks
- Highlight the main drivers of variation in pricing of services by hospitals nationally, including provider and payer market power
- Report on how hospitals and payers are leveraging publicly available rate data in their commercial rate negotiations through Clarify’s ongoing review of updates to data on negotiated prices