Our hats off to the UofL team, Abraham Gage and Michael Venable, for being change agents and jumping into payer price transparency data early. They wrote the code, got the servers, and focused on getting this data and turning it into millions in annual savings.
This is the vision of price transparency. Rebalancing the asymmetrical nature of healthcare pricing in this country by simply saying, “Hey, you are not giving me the fair rate in these specific areas based on your contract data that you published.”
One very important note: while the UofL team impressively parsed the payer price transparency data on their own, parsing and cleaning the data is a continually evolving challenge with the data and payer restrictions changing monthly. If you don’t have the time or focus to get this information, you don’t have to do it on your own. We provide a super easy-to-use portal where you can simply search any care delivery organization, health insurance carrier, and category of services (or specific billing code) and get all of the rate data you need returned in seconds.
Key Outcomes from UofL Health's Initiative
Using payer sourced price transparency data, UofL achieved a 33% increase in reimbursement for spine fusion procedures with MCC
Significant Increases in Reimbursement Rates
The use of price transparency data allowed UofL Health to secure strategic increases in reimbursement rates for various services. For example, they achieved a 33% increase in reimbursement for spine fusion procedures with MCC (Major Complications or Comorbidities). The overall percentage increase in rates from September 2023 to May 2024 was substantial for several services, indicating a successful negotiation process driven by the insights gained from the transparency data.
Enhanced Negotiating Position
Access to competitors' pricing data across multiple geographies provided UofL Health with a robust foundation to negotiate better rates. This transparency empowered the health system to avoid accepting lower rates and instead push for rates that reflect the market value of their services.
"The system is doing what the system should be doing, ensuring that the codes that are going to be generated yield a material return," highlighted the strategic advantage gained through detailed market intelligence.
Strategic Decision-Making
The transparency data informed UofL Health's market entry decisions and initial contract settings. This was particularly evident in their decision to establish a standalone imaging center to retain patients within their system and prevent them from being redirected to lower-cost providers by insurers. The data also helped UofL Health to avoid catastrophic disasters in M&A and joint ventures, ensuring better-informed decisions.
Validation and Accuracy
Ensuring the accuracy and reliability of the data was a critical step in the process. The team cross-verified the extracted data with internal claims and revenue cycle data, as well as corroborated findings with trusted partners. This meticulous validation process helped avoid pitfalls and ensured that the negotiation strategies were based on accurate and comprehensive data.
"Extracting value from TiC data takes effort and patience," emphasized the need for a dedicated approach to harness the full potential of transparency data.
Future Expectations
The team anticipates ongoing evolution in payer behavior and additional guidance from CMS. They expect that payers will continue to balance compliance with transparency requirements and protection of shareholder value.
The presentation underscores the importance of incorporating transparency data into the broader analytics portfolio to continuously identify and respond to market opportunities and threats.
Why Payer Transparency Matters
UofL Health's success story underscores the transformative potential of payer transparency data in leveling the playing field in healthcare pricing. By accessing and utilizing this data, healthcare providers can negotiate fairer rates, make informed strategic decisions, and ultimately improve their financial health.
At Payerset, we recognize that not every organization has the resources or expertise to navigate the complexities of payer transparency data. That's why we offer a user-friendly portal that simplifies this process. With our platform, you can quickly and easily access the rate data you need, empowering your contract negotiation.
Regardless of whether you opt for our solution, a competitor's, or decide to tackle it on your own, TAKE ACTION! Given the ease of accessing this data, it is quickly becoming negligent to ignore.