Most health insurers have released their rates. Now, experts detail what they are doing with the data

By Robert King / July 15, 2022

Major health insurers have released massive reams of data detailing their in- and out-of-network rates to comply with a new rule.

Now, experts are sifting through those data to identify trends that could affect contract negotiations with providers.

“So far so good, if you will, on compliance,” said Niall Brennan, chief analytics and privacy officer for Clarify Health, a healthcare analytics software company. “I don’t have a truly overarching picture right down to the smallest plans, but so many of the nationals and [Blue Cross plans] are participating. Even if some of the smaller plans are a little slower … we are probably catching the vast majority of rates.”

Third parties are now looking into how to use the data that have been released, which is a tall order. 

“The amount of data is massive,” said Marcus Dorstel, vice president of operations at Turquoise Health, which has created a consumer website to compare prices for hospitals. 

Dorstel said one payer could have tens of thousands of rate files since they must post for each plan and different types. Turquoise is so far sifting through half of a petabyte of data, an enormous unit of information. 

Dorstel said, for context, that the national Library of Congress has three petabytes of data, and Turquoise is “working that way to that size.”

Third parties are now ingesting and stitching the data together to explore potential trends in provider rates. Turquoise is putting together the information into a database where customers can query rates. 

Payers and providers can use the information for contract negotiations and benchmarking rates against similar provider-payer entities, Dorstel said. 

“We will make this available for patients as well,” he said. “We did this with the hospital rates data that you could search on our website. It will be a bit more difficult because of the sheer scale."

Clarify Health is also working within the next six to eight weeks to include the data in its commercially facing products, Brennan, who previously worked on price transparency for the Obama administration, told Fierce Healthcare. He added that the Clarify Health Institute will put out its own reports and trends within the data. 

Brennan also believes the rates will have a big impact on provider contract negotiations. 

“I think that providers are probably going to look at what their competitors are charging to similar health insurance plans,” he said. “It will be interesting to see where things can go.”

This is the first of three parts of new regulations for insurers surrounding price transparency. 

In 2023, payers will have to put up a website that has a price comparison tool that enables consumers to get an estimate of their cost-sharing responsibility for an item or service, according to the Centers for Medicare & Medicaid Services (CMS). The next year, the website must include estimates for all items and services. 

It is the latest effort by the federal government to increase price transparency in the healthcare industry.

Starting last year, hospitals were required to post rates for 300 shoppable services. However, compliance with the rule has been minimal and caused CMS to raise the fines for noncompliance starting this year.