By Dave Bailey
Back in October 2020 when the Transparency in Coverage mandate was finalized, there was some real optimism about the value it could deliver. It was thought that consumers could use the payer’s published rates to shop and compare options before receiving care, which would increase competition and reduce total costs. And just as important, many businesses and organizations in the healthcare space saw the data as a goldmine for commercial analysis and activity.
Jump to December 2022 and much of this optimism has waned. The payers did begin to publish their rates data by the July 1 deadline, but few consumers or businesses have found much value in it. The reasons include:
- Data Volume: each payer’s data is delivered in the form of tens of thousands of individual files that together can be as large as 250 terabytes (larger than all of Netflix, Wikipedia, and the Library
of Congress put together). All this data must be aggregated and updated on a monthly basis, which are staggering tasks of data manipulation and storage.
- Data Irregularities: payers published datasets have numerous issues that interfere with meaningful analysis. We've seen issues like spinal surgeries costing $14.95, and some very common procedures completely absent.
And these data are buried under a mountain of irrelevant data such as optometrist rates for C-section procedure codes. These issues must be addressed before the data can be useful.
- Data Context: the data that payers publish is raw with individual CPT codes that have not been grouped to represent an entire episode of care. And the prices for these procedures are the list price, not what was actually paid. Without curation, this raw data could give a distorted view of the market.
To capitalize on these challenges, some commercial vendors have rushed price transparency products to the market. But from what we have seen, no one has been able to solve the data challenges above. Nor have any of these vendors developed useful dashboards or visualization tools to help uncover tactical or strategic insights from the data.
So, is the promise of Price Transparency Data dead?
At Stratasan (now a division of Syntellis Performance Solutions) we say NO. We believe that Price Transparency Data
can be a helpful tool for healthcare organizations to better understand their market and uncover growth opportunities.
But here’s the thing: we don’t think Price Transparency data has huge value by itself. Instead, we believe this data must be used as a complement to our 835 data, which is the gold standard of claims data. Our 835 dataset has been cleaned, curated, and cross-walked to present a more complete view of the entire care encounter. And it represents the actual, fully adjudicated price paid by the payer.
We are currently working on a plan to incorporate Price Transparency Data into our 835 data and put them together into our market-leading analysis and visualization tools. Until we get to that point, we encourage you to continue to believe in the promise of Price Transparency Data but also beware of its many challenges.