It has been more than six months since insurers were required to release data on their prices, but researchers are finding the long-sought numbers pretty hard to understand.
And, in some cases, the files are so large only a supercomputer can handle them.
A new report from the Georgetown University Center for Children and Families seeks to make several reforms to the Transparency in Coverage rule to ensure the data are more usable and accessible by researchers. The goal is to ensure that the data can be used to help regulators and lawmakers target policies that can boost coverage affordability.
“The good news is that many of the access and usability problems stem from the technical specifications provided by the Centers for Medicare & Medicaid Services [CMS],” the report said. “Most can be fixed through administrative action and better enforcement, with minimum cost burdens for the plans and issuers.”
Starting July 1, 2022, insurers and plan issuers were required to publicly post their in-network provider rates for each covered item and service. The data also included the billed charges for out-of-network rates.
While most insurers have complied with the rule, the actual results have been disappointing to third parties and researchers.
The report said many of the data files are far too large to access without help from a supercomputer, and the pricing data are too hard to find and understand.
“To put it in lay terms, trying to locate a single provider in the [Transparency in Coverage] files is akin to trying to find a single word in a very large dictionary that isn’t in alphabetical order,” the report said. “This is in part because there is very little summary information or index information available.”
Some of the data also have questionable quality, like a lack of variation in contracts between payers and providers.
The report outlines several recommendations to CMS to fix the issue, including:
- Reducing the frequency of reporting from monthly to quarterly or even biannually. This will help give users more time for analyzing data and will reduce compliance burdens.
- Mandating the use of relational databases or file structures to help identify where there are similar or the same negotiated rates. Another option is to create a file structure that enables plans to post one rate for one item or provider if different plans share the same rate.
- Requiring clear and standardized labels for each file and include the provider’s National Provider Identifier number.
- Making insurers use the same file type across all users and use only a single source code for accessing the information.
- Imposing a limit on the size of the file to ensure it is not unreasonably large, the report said.
“While ultimately each plan or issuer would still need to publish the same volume of data, requiring them to post a greater number of smaller files will enable users with standard computing capacity to download and use the data,” the report said.
CMS told Fierce Healthcare that it is "very encouraged" by the innovation that it has seen since the rule was implemented to ensure that third parties and researchers can process the data.
"While the files containing the required data may be large and require appropriate tools to download and process, CMS envisions that those with sufficient core competencies will therefore be able to process the data to make it meaningful and actionable for consumers," the agency said.
Georgetown told Fierce Healthcare that it is also sharing the report with interested lawmakers.
The data requirement is the first associated with the transparency rule. Starting this year, most group and individual plans must disclose the personalized pricing information for all of their covered services or items via an online consumer tool or in paper upon request, CMS said on its website.