The Center for Medicare and Medicaid Services (CMS), which enforces hospital pricing transparency and transparency in coverage mandates, has always intended for this data to be used by the most important stakeholders in the medical system: the patients. While hospital pricing transparency data structure has improved in readability with annual updates, transparency in coverage data - which mandates monthly updates on negotiated rates with all in-network and out-of-network entities covered by payers, is far less accessible. Aggregating all pricing data into one single platform and automating its ingestion while dynamically updating with publishing timelines would emerge a picture of the healthcare pricing market for any scale. Thereby allowing any stakeholder in the healthcare system: the patient, provider, payer, or care system to estimate the true costs of their intended decisions. To realize this vision, our focus has produced an atlas of pricing data from publicly available pricing data from sources, including hospital pricing transparency, transparency in coverage data, and both state and federal level pricing data. While numerous applications already exist for payers and care systems to take advantage of this data, which our atlas also allows - our interface, coupled with our team of physicians, is driven to develop applications of our atlas to enrich the interaction between patients and their providers. At its core, healthcare is the conversation between patients and those who care for them. Our intuitive tool allows both to engage with each other and optimize expected care costs - creating a new landscape for shared decision-making. With our active physician team, we are creating this clinical context for the atlas and are excited to share what we are working on soon. Stay connected with us at sumhealth.org. Thank you Elion for the feature! #Pricingtransparency #Transparencyincoverage #CMS #Patientsfirst
Price transparency is a fascinating category that's undergone some significant changes over the past few years as a result of regulatory changes. In 2021, CMS stepped in to require both hospitals and payers to publish “machine-readable files” (MRFs) that contain charges, charge descriptions, and rates for insured and self-pay patients across a wide range of service codes. In response to the influx of hospital- and payer-provided MRFs, a number of companies, including Mathematica, Payerset, Serif Health, SumHealth, Trek Health, TALON, Turquoise Health, and Visible Charges, LLC, prepared to ingest this data and actually make it legible across a range of use cases. The differentiation between price transparency vendors initially came down to the quality of data, and vendors built robust pipelines using heuristics and data science to filter out irrelevant data. But vendors are aware that more competitors could drive down prices for high-quality data and are focused on moving downstream to build products and services incorporating price data for useful applications. To succeed in this space, vendors need to marry data quality with the requisite tooling for contract negotiations. But it seems the real winners here will ultimately be providers and payers, who stand to benefit from streamlined processes and less reliance on contracting consultants. We've covered this in more detail in this week's market map: https://lnkd.in/eVXX7Rpy
Thanks so much for sharing!