Data Transparency in Reimbursement Discussions

Data Transparency in Reimbursement Discussions

Level the Playing Field for More Productive Negotiations

By Jennifer Keller

There’s a discussion across healthcare about the need for greater price transparency. The talk is about whether or not patients should know the hard costs of medical procedures and how much they can expect to pay out of pocket for medical services. Armed with this information, they can shop around for care that fits their quality standards as well as their budget. 

At Stratasan, we feel there’s another layer of healthcare price transparency that’s needed—transparency that can level the playing field in provider-payer reimbursement negotiations. Both providers and payers are in need of more data to inform their negotiating position.

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Providers come to negotiations with the goal of higher reimbursements. In order to reach this goal, they need the right data insights to back their rate requests. Providers often know how much they want to grow, and the volumes they want to push. What they really need to know is where they can give and take in the negotiation process in order to reach those goals.

Payers may come to these meetings with more data than providers, but they often still feel blind to the market. Payers often don’t have all the data they need to see how their rates compare to the market, and to understand where they’re too low or too high.  

Interested in improving your provider-payer reimbursement negotiations? Sign up for our webinar, "3 Steps to Successful Reimbursement Negotiations.

If healthcare providers could soon be pushed to share prices with the public, there’s even more reason to be sure they can offer the most competitive prices possible. Armed with data-based insights that can better inform payer-provider reimbursement negotiations, providers will be better equipped to negotiate for competitive market reimbursement. Similarly, payers will have a better idea of how their rates compare to the market and where they can reasonably make adjustments. This, in turn, will allow providers to offer more competitive pricing to the public. 

Stratasan has partnered with Ancore Health to create the Market Reimbursement Analyzer (MRA). This tool allows for analysis by payer, provider, and service line, showing how reimbursement rates compare to the market. Utilizing 835 All-Payer Claims Data, MRA provides commercial reimbursement values by CPT/APC code for a particular market—including points of service such as physician offices, hospital outpatient departments, and ASCs.

Curious to see how it works? Check out this post from Ancore Health where you can interact with a dashboard and get a glimpse of the MRA solution's functionality.

Interact with Market Reimbursement Analyzer

The Takeaway

When you’re buying and selling a house, everyone knows what the market rate is. Unfortunately, that level of transparency isn’t always available in healthcare. Not everyone has the “market comps.” MRA levels the playing field for both sides. To learn more about how MRA can equip you with the data insights needed to successfully navigate your next negotiation, schedule a discovery call with one of our experts today.

Article by Jennifer Keller, Director of Solutions Marketing for Stratasan

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