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Demystify payer and provider contract 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 them during contract negotiations.
Milliman Transparent unifies disparate data from thousands of hospitals and payers, using our vast claims and contracting experience to improve data quality and usability. More than just a data warehouse, our solution incorporates 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 an API is 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, comparable data foundation.
Milliman healthcare industry experts and data scientists 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 has 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.
Actuarially sound percent of Medicare relativities for each contract and service type can also be viewed across markets and geographies.
Get data on demand using a web interface or consume it using an API.
Gain a deeper understanding of existing contractual agreements.
Harness data to gain leverage in payer and provider contracting efforts.
Understand your hot and cold spots, pricing anomalies, and network strength across payers and providers.
Support greater price transparency in healthcare and enable more engagement and choice for healthcare consumers.
Improve the market efficiency of contracting by enabling fair comparisons among providers and payers.
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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