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Demystify payer and provider contractual pricing data for better transparency across the industry
Milliman Price Transparency Solutions for Payers and Providers
Recent regulations require hospitals and health insurance payers to post contracted prices for medical services publicly online. However, the lack of consistency and accuracy makes this data difficult to consume and collate. Consumers need data that is comparable, accurate, easy to understand, and trustworthy to maximize transparency and choice. Payers and providers need fair price comparisons to use during contract negotiations.
Milliman has formed a strategic alliance with Turquoise Health to unify disparate data from thousands of hospitals and payers, then enrich the data using Milliman’s vast claims and contracting experience to improve data quality and usability. More than just a data warehouse, our Insights from Milliman Transparent incorporate proprietary utilization profiles and standardized pricing to create case-mix-weighted percent of Medicare relativities that enable fair contract comparisons. Intuitive online tools simplify access, and SFTP and APIs are available for extracting data on demand.
For the first time ever, coveted payer and provider contract pricing data is made easily accessible and understandable. Publicly available machine-readable pricing content is transformed into a unified, normalized data foundation, powered by our strategic alliance with Turquoise Health.
Millman has decades of experience analyzing healthcare data sets and providing intelligence to clients to support contract negotiations, benchmarking, pricing, and other critical business decisions. Milliman’s contract experts are partnering with organizations across the healthcare landscape to translate the transparency data into meaningful business insights.
Milliman healthcare industry experts, data scientists, and actuaries work together to flag data quality, trustworthiness, and sufficiency so users can make informed choices about how to use the information.
In order to compare the disparate payer and provider contract information, Milliman created utilization profiles by line of business and provider type. We combine the utilization profiles with our actuarial standardized price (GlobalRVUs) so that users can compare contracts with different contract structures and service codes using a nationwide Medicare benchmark tailored to the commercial market.
Actuarially sound percent of Medicare relativities for each contract and service type can also be viewed across markets and geographies, unlocking valuable competitive insights for payers and providers.
Get data on demand using a web interface or consume it using an API.
Gain a deeper understanding of existing contractual rates and agreement terms across all payers and providers.
Harness data to empower payers and providers with insights on contracted rates, network status, and discounts with actuarially sound analysis.
Understand contract strengths and weaknesses, pricing anomalies, contract structure, and network breadth across payers and providers. Identify opportunities to align price position with brand and strategy.
Assess current and new markets by geography / region, product mix, and networks.
Support greater price transparency in healthcare and enable more engagement and choice for healthcare consumers.
We discuss real-world examples and highlight key questions to show how Milliman Transparent contains the analytics that healthcare payers need to succeed in contracting.
Improving provider network identification could yield improved interpretation of price transparency data and processing burden.
Price transparency data unlocks a new era of healthcare analytics
New regulation aims to increase price transparency at hospitals, but challenges exist when extracting useful competitive information from their machine-readable files.
This report is the first in a series of updates Milliman will publish on the implementation trends for new regulations for hospital price transparency.
Regulations that took effect January 1, 2021 introduced a new level of price transparency in the U.S. healthcare system.
Recent changes in health plan and hospital transparency rules have potential to expand transparency to commercial market.
We look at challenges surrounding data we have actively tracked, identifying files from nearly 2,400 hospitals across the U.S.
In October 2020, the U.S. Department of Health and Human Services, Department of the Treasury, and the Department of Labor (collectively “the Departments”) released the Transparency in Coverage Final Rules (TiC…
Effective January 1, 2021, legislation required hospitals nationwide to publicly post a machine-readable file containing negotiated prices for all services provided at the hospital.
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Our consultants provide comprehensive risk services, including complex risk assessment, ERM, mortgage consulting, pricing/operational reviews, and more.
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