For the first time, a massive amount of payor and hospital price transparency data is publicly available. How can you use it to inform strategy and improve performance?
Over the last few years, the healthcare marketplace has changed dramatically due to new CMS requirements for hospital and payor price transparency. Hospitals now must publish their prices and reimbursement with negotiated payors for all services in machine-readable files (MRFs), and payors must publish their contracted rates with all providers. Having this information publicly available is a game changer not only for patients and consumers as they shop for services, but also for providers who now have access to extensive data on competitor rates and prices.
However, there are barriers to effectively utilizing price transparency data, including the size and complexity of the data files and evolving requirements for how they must be formatted. Professionals at Forvis Mazars can help hospitals and health systems break through these barriers by using services and tools that extract business-ready insights from the data to help inform strategy in three key areas: payor contracts, payment, and pricing.
This article will provide more details about how we can assist, along with examples of the data insights we provide.
Help Improve Payor Contract Negotiations With Rate Benchmarking
Our rate benchmarking service now includes a report containing critical insights based on payor price transparency data, displaying how a provider’s managed care contracted rates compare to competitors in their geographic region, market, and/or specialty. Your organization can use rate benchmarking information to help decide where to focus your efforts to negotiate more favorable rates with specific payors and for specific services and procedures.
| Competitor 1 | Competitor 2 | Competitor 3 | |
|---|---|---|---|
| Payor A | 15% | 30% | -10% |
| Payor B | -18% | 12% | -4% |
| Payor C | 26% | 17% | -8% |
| Payor D | -10% | 7% | -19% |
Monitor Payments to Help Reduce Revenue Leakage
We use payor price transparency data to help providers consistently receive payment in accordance with their contracted rates. We can work with your organization to help you establish a process for monitoring payment for inpatient and outpatient claims, identifying overpayments and underpayments as they occur, and checking in regularly with payors to resolve payment discrepancies. We also help institutionalize this process to support day-to-day revenue cycle activities.
Help Establish a Defensible Price Strategy
Hospital price transparency data allows us to generate reports that can provide actionable insights into how a provider’s prices compare to their peers overall and for specific departments and services. After helping your organization understand your market position, we can advise on price strategy and pricing models that are transparent and defensible with patients and consumers, as well as competitive and financially viable when considering costs and contracted rates.
Questions to Consider
As your organization considers how to effectively utilize price transparency data, you should ask the following questions:
- How does our organization’s payor pricing compare to peers?
- Is our organization collecting our negotiated rates?
- How do our organization’s services fit into the market?
- Is our pricing justified based on the services provided?
- How will consumers view our organization’s value?
Our professionals can help you leverage the data to find answers to these questions and use those answers to develop and execute data-driven strategies for payor contracting, payment, and pricing. With our deep knowledge and experience across healthcare finance, strategy, and performance improvement, we can assist organizations facing a wide range of challenges, including margin compression, acquisitions, and transactions. If you have questions or need assistance in any of these areas, please reach out to our team at Forvis Mazars today.